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A Prospective Evaluation of Patients Undergoing Surgery for the Palliation of an Advanced Malignancy

From the General Surgery Service (CDS), Walter Reed Army Medical Center, Washington, DC; and Memorial Sloan-Kettering Cancer Center (TJM, DPJ), New York, New York.

Correspondence: Address correspondence and reprint requests to: David P. Jaques, MD, Vice Chairman, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021; Fax: 212-717-3645; E-mail: jaquesd{at}mskcc.org

Background: Decisions regarding the use of surgical procedures for the palliation of symptoms caused by advanced malignancies require the highest level of surgical judgment. Prospective analysis of palliative surgical care may facilitate a more effective and representative evaluation of these patients.

Methods: Patients requiring surgery planned solely for the palliation of an advanced malignancy were offered entry onto this study. Outcome measurements were made before surgery and monthly thereafter until the patient’s death. Accepted techniques of pain assessment, quality of life, and functional status were used.

Results: Between May 1997 and December 1999, 26 patients were enrolled. Although 46% (12 of 26) of patients demonstrated improvement in pain control or quality of life after palliative surgery, these benefits lasted a median of only 3.4 months. Palliative surgery was associated with significant postoperative complications in 35% (9 of 26) patients.

Conclusions: Although many patients had no apparent demonstrable benefit from surgery, surgeons were able to identify a group of patients who experienced significant benefits after a palliative procedure. The relationships between the patient and family members and the surgeon play an important role in decision-making throughout the palliative phase of cancer treatment.

Key Words: Cancer • Outcome analysis • Pain • Palliation • Quality of life • Surgery

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