This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McCahill, L. E. Articles by Wagman, L. D. Search for Related Content PubMed PubMed Citation Articles by McCahill, L. E. Articles by Wagman, L. D. Related Collections Surgery

A Prospective Evaluation of Palliative Outcomes for Surgery of Advanced Malignancies

From the Division of Surgical Oncology (LEM), University of Vermont, Burlington, Vermont; and the Departments of General Oncologic Surgery (CC, DZJC, LDW), Biostatistics (DDS), and Nursing Research (TB, GJ, BRF), City of Hope National Medical Center, Duarte, California.

Correspondence: Address correspondence and reprint requests to: Laurence E. McCahill, MD, University of Vermont College of Medicine, Division of Surgical Oncology, UHC Campus, 1 South Prospect Street, Burlington, VT 05401; Fax: 802-847-0574; E-mail: larry.mccahill{at}vtmednet.org

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

This article has been cited by other articles:

				K. J. Brasel Quality-of-life Assessment in Palliative Care American Journal of Hospice and Palliative Medicine, June 1, 2007; 24(3): 231 - 235. [Abstract] [PDF]

				S. L. Wong When a Cure Isn't Possible... Do All Roads Lead to Palliation? Ann. Surg. Oncol., April 1, 2007; 14(4): 1245 - 1246. [Full Text] [PDF]

				Y. D. Podnos and L. D. Wagman The Surgeon and Palliative Care Ann. Surg. Oncol., April 1, 2007; 14(4): 1257 - 1263. [Abstract] [Full Text] [PDF]

				J. J. Yeh, S. Singer, M. F. Brennan, and D. P. Jaques Effectiveness of Palliative Procedures for Intra-Abdominal Sarcomas Ann. Surg. Oncol., December 1, 2005; 12(12): 1084 - 1089. [Abstract] [Full Text] [PDF]

				J. M. Galante, T. L. Bowles, V. P. Khatri, P. D. Schneider, J. E. Goodnight Jr, and R. J. Bold Experience and Attitudes of Surgeons Toward Palliation in Cancer Arch Surg, September 1, 2005; 140(9): 873 - 880. [Abstract] [Full Text] [PDF]