title: Factors influencing change of preoperative treatment intent in a gastrointestinal cancer practice.
abstract: BACKGROUND
  Postoperative assessment of indications for cancer directed surgical procedures frequently differs from preoperative plans.
  
  
  METHODS
  Specifically defined preoperative indications and postoperative results were followed prospectively over 48 months in a single surgeon academic practice, and relationships to postoperative outcomes evaluated.
  
  
  RESULTS
  Operations were performed on 406 patients with a median age of 61 (range: 18-90). Major operations (n = 303, 75%) involved 270 abdominal resections including pancreatectomies (37%), liver resections (23%), gastrectomies (19%), and others (21%). Preoperative curative (70%), diagnostic (38%), palliative (12%), access (9%), and non-cancer related therapy (21%) goals were in part combined in 176 patients (43%). Postoperative assessment differed from preoperative goals in 118 patients (29%). Predominant reasons were proof of benign disease (n = 35), incomplete resection (R1 or R2, n = 23), unresectability by laparoscopy (n = 21) or laparotomy (n = 21), or others (n = 18). Potential preoperative cure or palliation goals were not achieved in 37% or 15% of cases, respectively. Circumstances of changed treatment intent were specific for disease site.
  
  
  CONCLUSIONS
  Preoperative therapeutic intent frequently differs from postoperative assessments in gastrointestinal cancer, based on shortcomings in diagnosis or therapy. Formulations of precise operative indications are recommended to optimize individual outcomes and avoid unnecessary or ineffective procedures.
authors.affiliation: Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Division of Surgical Oncology, The Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA. r.schwarz@umdnj.edu
authors.forename: Roderich E
authors.initials: RE
authors.lastname: Schwarz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D003657:Decision Making; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D019160:Endosonography; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010347:Patient Care Planning; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult