Background: Despite increasing attention to end-of-life care in oncology, palliative surgery (PS) remains poorly defined. A survey to test the definition, assess the extent of use, and evaluate attitudes and goals of surgeons regarding PS was devised.
Methods: A survey of Society of Surgical Oncology (SSO) members.
Results: 419 SSO members completed a 110-item survey. Surgeons estimated 21% of their cancer surgeries as palliative in nature. Forty-three percent of respondents felt PS was best defined based on pre-operative intent, 27% based on post-operative factors, and 30% on patient prognosis. Only 43% considered estimated patient survival time an important factor in defining PS, and 22% considered 5-year survival rate important. The vast majority (95%) considered tumor still evident following surgery in a patient with poor prognosis constituted PS. Most surgeons felt PS could be procedures due to generalized illness related to cancer (80%) or related to cancer treatment complications (76%). Patient symptom relief and pain relief were identified as the two most important goals in PS, with increased survival the least important.
Conclusion: PS is a major portion of surgical oncology practice. Quality-of-life parameters, not patient survival, were identified as the most important goals of PS.
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Greenlee RT, Hill-Harmon MB, Murray T, et al. Cancer Statistics 2001.CA Cancer J Clin 2001;51:15–36.
Field MJ, Cassell CK.Approaching Death-Improving Care at the End of Life. Washington, D.C., National Academy Press 1997.
Halstead WJ. The results of radical operations for the cure of cancer of the breast.Ann Surg 1907;46:1–27.
Miner TJ, Jaques DP, Shriver C. Decision making on surgical palliation based on patient outcome data.A J Surg 1999;177:150–54.
Turner S, Marosszeky B, Timms I, et al. Malignant spinal cord compression: a prospective evaluation.Int J Radiat Oncol Biol Phys 1993;26:141–6.
Maranzano E, Latini P, Checcaglini F, et al. Radiation therapy in metastatic spinal cord compression. A prospective analysis of 105 consecutive patients.Cancer 1991;67:1311–7.
Boddie AW, Jr, McMurtrey MJ, Giacco GG, et al. Palliative total gastrectomy and esophagogastrectomy. A reevaluation.Cancer 1983;51:1195–200.
Branicki FJ, Law SY, Fok M, et al. Quality of life in patients with cancer of the esophagus and gastric cardia: a case for palliative resection.Arch Surg 1998;133:316–22.
Makela J, Haukipuro K, Laitinen S, et al. Palliative operations for colorectal cancer.Dis Colon Rectum 1990;33:846–50.
Faneyte IF, Rutgers EJ, Zoetmulder FA. Chest wall resection in the treatment of locally recurrent breast carcinoma: indications and outcome for 44 patients.Cancer 1997;80:886–91.
Lillemoe KD, Cameron JL, Hardacre JM, et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial.Ann Surg 1999;230:322–8; discussion 328–30.
Temple WJ, Ketcham AS. Surgical palliation for recurrent rectal cancers ulcerating in the perineum.Cancer 1990;65:1111–4.
Rosen SA, Buell JF, Yoshida A, et al. Initial presentation with stage IV colorectal cancer: how aggressive should we be?Arch Surg 2000;135:530–4; discussion 534–5.
Krouse RK, Nelson RA, Ferrell BR, et al. Surgical Palliation at a Cancer Center: Incidence and Outcomes.Arch Surg 2001;136:773–8.
Ball ABS, Baum M, Breach NM, et al. Surgical palliation. In: Doyle D, Hanks GWC, MacDonald N, eds.Oxford Textbook of Palliative Medicine (2nd ed). Oxford, Oxford University Press 1998:282–99.
Christakis NA, Lamont EB. Extent and determinants of error in doctors’ prognoses in terminally ill patients: Prospective cohort study.British Medical Journal 2000;320:469–72.
Porter GA, Skibber JM. Outcomes research in surgical oncology.Ann Surg Oncol 2000;7:367–75.
Tsao JI, Nimura Y, Kamiya J, et al. Management of hilar cholangiocarcinoma: comparison of an American and a Japanese experience.Ann Surg 2000;232:166–74.
Liu SK, Church JM, Lavery IC, et al. Operation in patients with incurable colon cancer-is it worthwhile?Dis Colon Rectum 1997;40:11–14.
Windham TC, Pearson AS, Skibber JM, et al. Significance and management of local recurrences and limited metastatic disease in the abdomen.Surg Clin North Am 2000;80:761–74.
Porzsolt F, Wirth A, Mayer-Steinacker R, et al. Quality assurance by specification and achievement of goals in palliative cancer treatment.Cancer Treat Rev 1996;22 Suppl A:41–9.
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McCahill, L.E., Krouse, R., Chu, D. et al. Indications and use of palliative surgery-results of society of surgical oncology survey. Ann Surg Oncol 9, 104–112 (2002). https://doi.org/10.1245/aso.2002.9.1.104
- Palliative Care
- Gastric Outlet Obstruction
- Palliative Care Specialist
- Recurrent Rectal Cancer
- Metastatic Spinal Cord Compression