An Assessment of the Frequency of Palliative Procedures in Thoracic Surgery

Freeman, Richard K.; Arevalo, Gabriel; Ascioti, Anthony J.; Dake, Megan; Mahidhara, Raja S.

doi:10.1016/j.jsurg.2017.02.011

Cited by 10 publications

(5 citation statements)

References 14 publications

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“…Vascular surgeons often prioritize symptom control and quality of life in their approach to conditions like peripheral vascular disease and may view these procedures as palliative interventions (15). In thoracic surgery, as much as 23% of all procedures performed are palliative (16). Within comprehensive cancer centers, palliative procedures make up a significant minority of all cases performed by other surgical subspecialties, such as neurosurgery (46%) and orthopedic surgery (31%) (14).…”

Section: Review Articlementioning

confidence: 99%

“…Some common indications for palliative surgery are malignant bowel and biliary obstruction, management of extensive fungating skin and soft tissue disease, peripheral arterial disease, pleural and pericardial effusions, tracheobronchial obstructions, hemoptysis and bronchopleural fistula (16). These conditions can cause debilitating symptoms that can be difficult to control.…”

Section: Review Articlementioning

confidence: 99%

“…The largest prospective study of palliative surgery outcomes, encompassing 1,022 patients, revealed an 11% 30-day mortality (20). Similarly, a retrospective review of 884 palliative thoracic surgery procedures found 11% of patients died before leaving the hospital (16). While prolonging survival is not the main goal of palliative surgery, this significant risk of early postoperative mortality is relevant when discussing an individual patient's treatment preferences.…”

Section: Risks and Benefits Of Palliative Surgerymentioning

confidence: 99%

“…This shows that many patients survive long enough to see substantial benefits from palliative surgery. A large retrospective study of palliative thoracic procedures similarly had a median survival of 110 days and most patients were able to discharge home (16).…”

Section: Risks and Benefits Of Palliative Surgerymentioning

confidence: 99%

“…Surgeons are often consulted for palliative procedures in patients who have not received palliative consultation. At one institution, only 14% of thoracic patients who received palliative procedures had palliative care assessment before surgical consultation (16). Only an additional 5% of patients received a palliative care consultation during their stay, and it is unclear if those additional consultations occurred before or after the surgical procedure.…”

Section: What Surgeons Can Bring To the Palliative Care Teammentioning

confidence: 99%

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Palliative surgery and the surgeon’s role in the palliative care team: a review

Louie¹,

Miner²

2022

Ann Palliat Med

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This review focuses on the role of palliative surgery in the care of the palliative care patient, and the appropriate role of the surgeon. The surgeon has much to bring to the palliative care team. The surgeon's role goes beyond the technical requirements of the palliative procedure, which itself must be strictly defined, and has recognized utility for improving quality of life in selected patients. These benefits may be substantial, but come at significant risk; requiring careful balancing of risks and benefits that is most completely understood by the surgeon. The surgeon's judgement can help determine which procedure best meets a patient's goals. The complex dialogue involved in the decision to undergo a palliative operation requires excellent communication between the palliative care team, the patient, and their family. Integrating the surgeon into the palliative care team could help with earlier initiation of those palliative discussions, and assist deliberation of palliative surgery. Surgeons also understand the importance of communication around palliative surgical interventions and have adapted several teaching models to the specifics of this crucial communication. A palliative team combining both surgeons and palliative care physicians may promote goalconcordant decision-making and remove barriers to communication and team engagement. The future of palliative surgery research will involve measures of success that go beyond physiology or mortality, to include more evaluations of communication and patient goals.

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Section: Review Articlementioning

confidence: 99%

Section: Review Articlementioning

confidence: 99%