Abstract
Background
While surgery is generally necessary for most solid-organ cancers, curative-intent resection is occasionally aborted due to unanticipated unresectability or occult metastases. Following aborted cancer surgery (ACS), patients have unique and complex care needs and yet little is known about the optimal approach to their management.
Objective
The aim of this study was to define the practice patterns and perspectives of an international cohort of cancer surgeons on the management of ACS.
Methods
A validated survey assessing surgeon perspectives on patient care needs and management following ACS was developed. The survey was distributed electronically to members of the Society of Surgical Oncology (SSO).
Results
Among 190 participating surgeons, mean age was 49 ± 11 years, 69% were male, 61% worked at an academic institution, and most had a clinical practice focused on liver/pancreas (30%), breast (23%), or melanoma/sarcoma cancers (20%). Participants estimated that ACS occurred in 7 ± 6% of their cancer operations, most often due to occult metastases (67%) or local unresectability (30%). Most surgeons felt (very) comfortable addressing their patients’ surgical needs (92%) and cancer treatment-related questions (90%), but fewer expressed comfort addressing psychosocial needs (83%) or symptom-control needs (69%). While they perceived discussing next available therapies as the patients’ most important priority after ACS, surgeons reported avoiding postoperative complications as their most important priority (p < 0.001). While 61% and 27% reported utilizing palliative care and psychosocial oncology, respectively, in these situations, 46% noted care coordination as a barrier to addressing patient care needs.
Conclusions
Results from this SSO member survey suggest that ACS is relatively common and associated with unique patient care needs. Surgeons may feel less comfortable assessing psychosocial and symptom-control needs, highlighting the need for novel patient-centered approaches.
Similar content being viewed by others
References
Guzzo TJ, Rogers CG, Deng CY, et al. Outcomes of patients after aborted radical cystectomy for intraoperative findings of metastatic disease. BJU Int. 2008;102(11):1539–43. https://doi.org/10.1111/j.1464-410X.2008.07877.x.
Pisters PW, Lee JE, Vauthey JN, Charnsangavej C, Evans DB. Laparoscopy in the staging of pancreatic cancer. Br J Surg. 2001;88(3):325–37. https://doi.org/10.1046/j.1365-2168.2001.01695.x.
Guerrero W, Munene G, Dickson PV, et al. Outcome and factors associated with aborted cytoreduction for peritoneal carcinomatosis. J Gastrointest Oncol. 2018;9(4):664–73. https://doi.org/10.21037/jgo.2018.04.05.
Cloyd JM, Dalmacy D, Ejaz A, Pawlik TM. Rates and outcomes of aborted cancer surgery among older patients with pancreatic cancer: a SEER-medicare study. J Gastrointest Surg. 2022;26(9):1957–9. https://doi.org/10.1007/s11605-022-05289-x.
Beal EW, Ahmed A, Grotz T, et al. Trends in the indications for and short-term outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Am J Surg. 2020;219(3):478–83. https://doi.org/10.1016/j.amjsurg.2019.09.017.
Konstadoulakis MM, Roayaie S, Gomatos IP, et al. Fifteen-year, single-center experience with the surgical management of intrahepatic cholangiocarcinoma: operative results and long-term outcome. Surgery. 2008;143(3):366–74. https://doi.org/10.1016/j.surg.2007.10.010.
Buettner S, Wilson A, Margonis GA, et al. Assessing trends in palliative surgery for extrahepatic biliary malignancies: a 15-year multicenter study. J Gastrointest Surg. 2016;20(8):1444–52. https://doi.org/10.1007/s11605-016-3155-6.
Shah MM, Ajay PS, Meltzer RS, et al. The aborted Whipple: why, and what happens next? J Surg Oncol. 2022;125(4):642–5. https://doi.org/10.1002/jso.26781.
Guo M, Leuschner T, Lopez-Aguiar A, et al. Aborted cancer surgery at a single tertiary cancer center: rates, reasons, and outcomes. Surgery. 2023;174(4):880–5. https://doi.org/10.1016/j.surg.2023.06.026.
Stevens L, Wells-Di Gregorio S, Lopez-Aguiar AG, et al. Patient experiences after aborted cancer surgery: a qualitative study. Ann Surg Oncol. 2023;30(11):6844–51. https://doi.org/10.1245/s10434-023-14046-6.
Schreiber L, Zeh R, Monsour C, et al. Multi-specialty physician perspectives on barriers and facilitators to the use of neoadjuvant therapy for pancreatic ductal adenocarcinoma. HPB (Oxford). 2022;24(6):833–40. https://doi.org/10.1016/j.hpb.2021.10.010.
Azari FS, Vollmer CM, Roses RE, et al. A contemporary analysis of palliative procedures in aborted pancreatoduodenectomy: morbidity, mortality, and impact on future therapy. Surgery. 2020;168(6):1026–31. https://doi.org/10.1016/j.surg.2020.06.041.
Insulander J, Sanjeevi S, Haghighi M, et al. Prognosis following surgical bypass compared with laparotomy alone in unresectable pancreatic adenocarcinoma. Br J Surg. 2016;103(9):1200–8. https://doi.org/10.1002/bjs.10190.
Derogatis LR, Morrow GR, Fetting J, et al. The prevalence of psychiatric disorders among cancer patients. JAMA. 1983;249(6):751–7. https://doi.org/10.1001/jama.249.6.751.
Wang YH, Li JQ, Shi JF, et al. Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Mol Psychiatry. 2020;25(7):1487–99. https://doi.org/10.1038/s41380-019-0595-x.
Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psychooncology. 2001;10(1):19–28. https://doi.org/10.1002/1099-1611(200101/02)10:1%3c19::aid-pon501%3e3.0.co;2-6.
Gehlbach H, Artino AR, Durning S. AM last page: survey development guidance for medical education researchers. Acad Med. 2010;85(5):925. https://doi.org/10.1097/ACM.0b013e3181dd3e88.
Cloyd JM, Stevens L. Outcomes of aborted cancer surgery: a call for patient-centered research. Support Care Cancer. 2022;30(3):1907–10. https://doi.org/10.1007/s00520-021-06701-z.
Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008;16(7):791–801. https://doi.org/10.1007/s00520-007-0380-2.
Reilly CM, Bruner DW, Mitchell SA, et al. A literature synthesis of symptom prevalence and severity in persons receiving active cancer treatment. Support Care Cancer. 2013;21(6):1525–50. https://doi.org/10.1007/s00520-012-1688-0.
Henselmans I, Helgeson VS, Seltman H, de Vries J, Sanderman R, Ranchor AV. Identification and prediction of distress trajectories in the first year after a breast cancer diagnosis. Health Psychol. 2010;29(2):160–8. https://doi.org/10.1037/a0017806.
Gil F, Costa G, Hilker I, Benito L. First anxiety, afterwards depression: psychological distress in cancer patients at diagnosis and after medical treatment. Stress Health. 2012;28(5):362–7. https://doi.org/10.1002/smi.2445.
Puts MT, Papoutsis A, Springall E, Tourangeau AE. A systematic review of unmet needs of newly diagnosed older cancer patients undergoing active cancer treatment. Support Care Cancer. 2012;20(7):1377–94. https://doi.org/10.1007/s00520-012-1450-7.
Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160–74. https://doi.org/10.1016/S1470-2045(11)70002-X.
Kuhnt S, Brähler E, Faller H, et al. Twelve-month and lifetime prevalence of mental disorders in cancer patients. Psychother Psychosom. 2016;85(5):289–96. https://doi.org/10.1159/000446991.
DiMatteo MR, Haskard-Zolnierek KB. Impact of depression on treatment adherence and survival from cancer. Depression Cancer. 2011. https://doi.org/10.1002/9780470972533.
Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychol Med. 2010;40(11):1797–810. https://doi.org/10.1017/S0033291709992285.
Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer. 2009;115(22):5349–61. https://doi.org/10.1002/cncr.24561.
Petticrew M, Bell R, Hunter D. Influence of psychological coping on survival and recurrence in people with cancer: systematic review. BMJ. 2002;325(7372):1066. https://doi.org/10.1136/bmj.325.7372.1066.
Passik SD, Dugan W, McDonald MV, Rosenfeld B, Theobald DE, Edgerton S. Oncologists’ recognition of depression in their patients with cancer. J Clin Oncol. 1998;16(4):1594–600. https://doi.org/10.1200/JCO.1998.16.4.1594.
Fagerlind H, Kettis Å, Glimelius B, Ring L. Barriers against psychosocial communication: oncologists’ perceptions. J Clin Oncol. 2013;31(30):3815–22. https://doi.org/10.1200/JCO.2012.45.1609.
Raskin W, Harle I, Hopman WM, Booth CM. Prognosis, treatment benefit and goals of care: What do oncologists discuss with patients who have incurable cancer? Clin Oncol (R Coll Radiol). 2016;28(3):209–14. https://doi.org/10.1016/j.clon.2015.11.011.
Chou WS, Hamel LM, Thai CL, et al. Discussing prognosis and treatment goals with patients with advanced cancer: a qualitative analysis of oncologists’ language. Health Expect. 2017;20(5):1073–80. https://doi.org/10.1111/hex.12549.
Maguire P. Improving the detection of psychiatric problems in cancer patients. Soc Sci Med. 1985;20(8):819–23. https://doi.org/10.1016/0277-9536(85)90336-3.
Greer JA, Jackson VA, Meier DE, Temel JS. Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA Cancer J Clin. 2013;63(5):349–63. https://doi.org/10.3322/caac.21192.
Greer JA, Applebaum AJ, Jacobsen JC, Temel JS, Jackson VA. Understanding and addressing the role of coping in palliative care for patients with advanced cancer. J Clin Oncol. 2020;38(9):915–25. https://doi.org/10.1200/JCO.19.00013.
Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42. https://doi.org/10.1056/NEJMoa1000678.
Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741–9. https://doi.org/10.1001/jama.2009.1198.
Temel JS, Greer JA, El-Jawahri A, et al. Effects of early integrated palliative care in patients with lung and GI cancer: a randomized clinical trial. J Clin Oncol. 2017;35(8):834–41. https://doi.org/10.1200/JCO.2016.70.5046.
Morita T, Miyashita M, Tsuneto S, Sato K, Shima Y. Late referrals to palliative care units in Japan: nationwide follow-up survey and effects of palliative care team involvement after the Cancer Control Act. J Pain Symptom Manage. 2009;38(2):191–6. https://doi.org/10.1016/j.jpainsymman.2008.09.011.
Zimmermann C, Riechelmann R, Krzyzanowska M, Rodin G, Tannock I. Effectiveness of specialized palliative care: a systematic review. JAMA. 2008;299(14):1698–709. https://doi.org/10.1001/jama.299.14.1698.
Schenker Y, Park SY, Maciasz R, Arnold RM. Do patients with advanced cancer and unmet palliative care needs have an interest in receiving palliative care services? J Palliat Med. 2014;17(6):667–72. https://doi.org/10.1089/jpm.2013.0537.
Hoerger M, Greer JA, Jackson VA, et al. Defining the elements of early palliative care that are associated with patient-reported outcomes and the delivery of end-of-life care. J Clin Oncol. 2018;36(11):1096–102. https://doi.org/10.1200/JCO.2017.75.6676.
Greer JA, Jacobs JM, El-Jawahri A, et al. Role of patient coping strategies in understanding the effects of early palliative care on quality of life and mood. J Clin Oncol. 2018;36(1):53–60. https://doi.org/10.1200/JCO.2017.73.7221.
Wong SL, McCahill LE, Edge SB, et al. Getting to better cancer care: results of a society of surgical oncology survey. Ann Surg Oncol. 2008;15(9):2363–71. https://doi.org/10.1245/s10434-008-9946-6.
Balch CM. Prescribing patterns of surgical oncologists: are we surgeons, oncologists, or both? Results of a society of surgical oncology survey. Ann Surg Oncol. 2007;14(10):2685–6. https://doi.org/10.1245/s10434-007-9578-2.
Funding
This research was supported in part by funding from the American Cancer Society (PEP-22-028-01-CTSP) and the Pelotonia Intramural Research Program.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
Alexandra G. Lopez-Aguiar, Angela Sarna, Sharla Wells-DiGregorio, Emily Huang, Peter J. Kneuertz, Joal Beane, Alex Kim, Aslam Ejaz, Timothy M. Pawlik, and Jordan M. Cloyd have no conflicts of interest to report.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Lopez-Aguiar, A.G., Sarna, A., Wells-DiGregorio, S. et al. Surgeon Perspectives on the Management of Aborted Cancer Surgery: Results of a Society of Surgical Oncology Member Survey. Ann Surg Oncol 31, 2295–2302 (2024). https://doi.org/10.1245/s10434-023-14804-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-023-14804-6