Annals of Surgical Oncology

, Volume 10, Issue 6, pp 654–663 | Cite as

A Prospective Evaluation of Palliative Outcomes for Surgery of Advanced Malignancies

  • Laurence E. McCahill
  • David D. Smith
  • Tami Borneman
  • Gloria Juarez
  • Carey Cullinane
  • David Z. J. Chu
  • Betty R. Ferrell
  • Lawrence D. Wagman
Original Articles

Abstract

Background: We prospectively evaluated the effectiveness of major surgery in treating symptoms of advanced malignancies.

Methods: Fifty-nine patients were evaluated for major symptoms of intent to treat and were followed up until death or last clinical evaluation. Surgeons identified planned operations before surgery as either curative or palliative and estimated patient survival time. An independent observer assessed symptom relief. A palliative surgery outcome score was determined for each symptomatic patient.

Results: Surgeons identified 22 operations (37%) as palliative intent and 37 (63%) as curative intent. The median overall survival time was 14.9 months and did not differ between curative and palliative operations. Surgical morbidity was high but did not differ between palliative (41%) and curative (44%) operations. Thirty-three patients (56%) were symptomatic before surgery, and major symptom resolution was achieved after surgery in 26 (79%) of 33. Good to excellent palliation, defined as a palliative surgery outcome score >70, was achieved in 64% of symptomatic patients.

Conclusions: Most symptomatic patients with advanced malignancies undergoing major operations attained good to excellent symptom relief. Outcome measurements other than survival are feasible and can better define the role of surgery in multimodality palliative care. A new outcome measure to evaluate major palliative operations is proposed.

Key Words

Palliative surgery Quality of life Outcomes Advanced malignancy 

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Copyright information

© The Society of Surgical Oncology, Inc. 2003

Authors and Affiliations

  • Laurence E. McCahill
    • 1
    • 5
  • David D. Smith
    • 3
  • Tami Borneman
    • 4
  • Gloria Juarez
    • 4
  • Carey Cullinane
    • 2
  • David Z. J. Chu
    • 2
  • Betty R. Ferrell
    • 4
  • Lawrence D. Wagman
    • 2
  1. 1.Division of Surgical OncologyUniversity of VermontBurlington
  2. 2.Department of General Oncologic SurgeryCity of Hope National Medical CenterDuarte
  3. 3.Department of BiostatisticsCity of Hope National Medical CenterDuarte
  4. 4.Department of Nursing ResearchCity of Hope National Medical CenterDuarte
  5. 5.University of Vermont College of Medicine, Division of Surgical OncologyBurlington

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