Abstract
Background
We sought to determine the clinical presentation, management, and outcomes associated with surgical consultation for symptom palliation in oncology inpatients.
Materials and methods
We reviewed the medical records of inpatients for whom surgical consultations were requested (January 2000 to September 2006) at a tertiary referral cancer center to identify those who underwent surgical palliative evaluation (defined as consultation for symptoms attributable to an advanced or incurable malignancy). We used the Cox proportional hazards model to identify prognostic factors associated with overall survival (OS) and logistic regression to identify factors associated with surgical intervention.
Results
Surgical consultation was requested for 1,102 inpatients; 442 (40%) met the criteria for surgical palliative evaluation. Gastrointestinal obstruction was the most common complaint (43%), while wound complications/infection and gastrointestinal bleeding accounted for 10% and 8%, respectively. The median OS was 2.9 months. Adverse prognostic factors for OS included ≥2 radiologically evident disease sites (HR = 1.4; 95% CI, 1.1–1.8) and carcinomatosis/sarcomatosis (HR = 1.4; 95% CI, 1.1–1.7). Palliative surgical procedures were performed in 119 (27%) patients, with a 90-day morbidity and mortality rate of 40% and 7% respectively. Patients with wound complications (OR = 3.3; 95% CI, 1.4–7.6), intestinal obstruction (OR = 1.9; 95% CI, 1.1–3.2), or an intact primary/recurrent tumor (OR = 3.6; 95% CI, 2.2–6.0) were more likely to undergo surgical intervention. Patients with ascites were less likely to undergo surgery (OR = 0.4; 95% CI, 0.2–0.8).
Conclusions
Surgical palliative evaluations accounted for 40% of inpatient surgical consultations. Given that OS in this population is short and surgery is associated with considerable morbidity and mortality, non-operative management is desirable.
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References
A predictive model for aggressive non-Hodgkin’s lymphoma. The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. N Engl J Med 329:987–994. doi:10.1056/NEJM199309303291402
American Cancer Society (2007) Cancer facts and figures 2007. American Cancer Society, Atlanta
World Health Organization (2002) National cancer control programmes: policies and managerial guidelines, 2nd edn. World Health Organization, Geneva
Cox D (1972) Regression models and life tables (with discussion). J Roy Stat Soc Ser B 34:187–220
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. doi:10.1097/01.sla.0000133083.54934.ae
Feuer DJ, Broadley KE, Shepherd JH et al (1999) Systematic review of surgery in malignant bowel obstruction in advanced gynecological and gastrointestinal cancer. The Systematic Review Steering Committee. Gynecol Oncol 75:313–322. doi:10.1006/gyno.1999.5594
Gripp S, Moeller S, Bolke E et al (2007) Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression. J Clin Oncol 25:3313–3320. doi:10.1200/JCO.2006.10.5411
Kaplan E, Meier P (1958) Nonparametric estimator from incomplete observations. J Am Stat Assoc 53:457–481. doi:10.2307/2281868
Krebs HB, Goplerud DR (1983) Surgical management of bowel obstruction in advanced ovarian carcinoma. Obstet Gynecol 61:327–330
Krouse RS, Nelson RA, Farrell BR et al (2001) Surgical palliation at a cancer center: incidence and outcomes. Arch Surg 136:773–778. doi:10.1001/archsurg.136.7.773
Legendre H, Vanhuyse F, Caroli-Bosc FX et al (2001) Survival and quality of life after palliative surgery for neoplastic gastrointestinal obstruction. Eur J Surg Oncol 27:364–367. doi:10.1053/ejso.2001.1120
McCahill LE (2004) Methodology for scientific evaluation of palliative surgery. Surg Oncol Clin N Am 13:413–427. doi:10.1016/j.soc.2004.03.008
McCahill LE, Dunn GP, Mosenthal AC et al (2004) Palliation as a core surgical principle: part 1. J Am Coll Surg 199:149–160. doi:10.1016/j.jamcollsurg.2004.04.009
McCahill LE, Krouse R, Chu D et al (2002) Indications and use of palliative surgery—results of Society of Surgical Oncology survey. Ann Surg Oncol 9:104–112. doi:10.1245/aso.2002.9.1.104
McCahill LE, Krouse RS, Chu DZ et al (2002) Decision making in palliative surgery. J Am Coll Surg 195:411–422. doi:10.1016/S1072-7515(02)01306-6
McCahill LE, Smith DD, Borneman T et al (2003) A prospective evaluation of palliative outcomes for surgery of advanced malignancies. Ann Surg Oncol 10:654–663. doi:10.1245/ASO.2003.06.011
Miner TJ (2005) Palliative surgery for advanced cancer: lessons learned in patient selection and outcome assessment. Am J Clin Oncol 28:411–414. doi:10.1097/01.coc.0000158489.82482.2b
Miner TJ, Brennan MF, Jaques DP (2004) A prospective, symptom related, outcomes analysis of 1022 palliative procedures for advanced cancer. Ann Surg 240:719–726
Miner TJ, Jaques DP, Karpeh MS et al (2004) Defining palliative surgery in patients receiving noncurative resections for gastric cancer. J Am Coll Surg 198:1013–1021. doi:10.1016/j.jamcollsurg.2004.02.007
Podnos YD, Juarez G, Pameijer C et al (2007) Impact of surgical palliation on quality of life in patients with advanced malignancy: results of the decisions and outcomes in palliative surgery (DOPS) trial. Ann Surg Oncol 14:922–928. doi:10.1245/s10434-006-9238-y
Podnos YD, Juarez G, Pameijer C et al (2007) Surgical palliation of advanced gastrointestinal tumors. J Palliat Med 10:871–876. doi:10.1089/jpm.2006.0174
Turnbull AD, Guerra J, Starnes HF (1989) Results of surgery for obstructing carcinomatosis of gastrointestinal, pancreatic, or biliary origin. J Clin Oncol 7:381–386
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Badgwell, B.D., Smith, K., Liu, P. et al. Indicators of surgery and survival in oncology inpatients requiring surgical evaluation for palliation. Support Care Cancer 17, 727–734 (2009). https://doi.org/10.1007/s00520-008-0554-6
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DOI: https://doi.org/10.1007/s00520-008-0554-6