Overview of Palliative Surgery: Principles and Priorities

Hanna, Jennifer M.; Blazer, Dan G.; Mosca, Paul J.

doi:10.4172/2165-7386.1000132

Cited by 11 publications

(13 citation statements)

References 26 publications

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“…1 The goal of palliative care is to achieve the best quality of life for patients and their families. 4,8 Surgical palliation of malignancy is defined best as a procedure used with the primary intention of improving quality of life or relieving symptoms caused by an advanced malignancy. 1 The World Health Assembly states that palliative care is "an ethical responsibility, irrespective of whether the disease or condition can be cured".…”

Section: Discussionmentioning

confidence: 99%

“…As such, many patients undergoing palliative surgical procedures may have a longer predicted survival than some patients undergoing procedures that are not classically viewed as 'palliative'. 4 As palliative care gains increasing traction as a specialty and becomes increasingly pervasive among health care institutions, surgeons have an opportunity, and arguably, an obligation to be engaged in shaping palliative care in surgery. 5 Previously it was taught that in advanced/incurable disease -chemotherapy is the treatment of choice, radiation only for symptomatic lesions, cure or even long-term progression free survival is not likely and surgery was rarely considered, it was like passive euthanasia-patient left to die without any intervention.…”

Section: Discussionmentioning

confidence: 99%

“…In some cases, the only realistic alternative to aggressive surgery may be supportive care or hospice, in which case major surgery would be a more attractive option in a favourable and motivated candidate. 4 The decision-making points for palliative surgery like expectations following the surgery, the resources available, cost issues, feasibility, expected degree of symptom resolution, durability of the procedure must be discussed with the patient and attenders and they should be taken into confidence.…”

Section: Discussionmentioning

confidence: 99%

“…1,3 Palliative surgery is generally refers to surgery performed with the intent of improving quality of life or relieving symptoms caused by advanced disease Palliative surgery is frequently confused with or used interchangeably with non-curative surgery. 4 In fact, the key difference between palliative and non-curative surgery lies in the intent of surgery, namely the intent to provide asymptomatic patients with an oncologic cure in non-curative surgery versus the intent to relieve symptoms without consideration of oncologic benefit in palliative surgery. 5,6 The main goals of palliative gastrointestinal surgery are restoration of regular alimentary passage, relief of tumor-related symptoms (pain, bleeding, hormonal symptoms), and prevention of tumor-related complications (bleeding, obstruction, and perforation).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Palliative surgery in gastrointestinal malignancy: experience from a regional cancer centre

Das¹,

Pandey²,

Deavi³

et al. 2020

Int Surg J

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Background: With so much burden of advanced incurable disease, the role of palliative surgery is paramount for gastrointestinal malignancies improving quality of life. Aim of the study was to study the indications, risks and outcome of palliative surgeries in gastrointestinal malignancies, the burden of disease requiring palliative surgery, and to describe strategies to improve end of life care.Methods: All the patients diagnosed with gastrointestinal malignancy and who underwent palliative surgery between January 2017 and December 2017 were analysed.Results: A total of 186 cases underwent palliative surgery. The most common age group affected was between 50-60 years and the mean age was 54.55 years. Stomach was the most common primary consisting of 58.60% followed by colorectal (23.66%), small intestine (9.68%), hepato-pacreatico-billiary (4.30%), and oesophageal (3.76%) primary. Major complications were seen in 4.84% of cases. Average symptomatic relief was observed for 5.5 months in cases of stomach and 7 months in case of colorectal malignancies. 35.48% cases were alive at the end of one year.Conclusions: Present study concludes that palliative surgery improves quality of life of the patient, provides them with time to accept death and live rest of the life in a dignified manner.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Palliative surgery in gastrointestinal malignancy: experience from a regional cancer centre

Das¹,

Pandey²,

Deavi³

et al. 2020

Int Surg J

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“…In der Palliativsituation beim kolorektalen Karzinom sollte sich die Rolle der Chirurgie aufgrund der meist hohen Morbidität und Mortalität operativer Eingriffe auf das Notwendigste beschränken [1,2].…”

Section: Introductionunclassified

Palliativchirurgie beim kolorektalen Karzinom – welche Faktoren können bei der Wahl des operativen Vorgehens helfen?

Konopke¹,

Schubert²,

Stöltzing³

et al. 2020

Zentralbl Chir

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Zusammenfassung Hintergrund Das chirurgische Vorgehen beim kolorektalen Karzinom (KRK) in der Palliativsituation lässt sich nur unzureichend standardisieren. Die vorliegende Studie wurde zur Identifikation von Kriterien für den Entscheid hinsichtlich Resektion des Malignoms mit oder ohne primäre Anastomose initiiert. Patienten/Material und Methoden In einer unizentrischen retrospektiven Analyse wurden 103 Patienten nach palliativer Resektion eines KRK mit oder ohne zeitgleiche Anastomose untersucht. Durch univariate und logistische Regressionsanalyse erfolgte die Beurteilung des Einflusses von insgesamt 40 Faktoren auf die postoperative Morbidität und Mortalität. Ergebnisse In 46 Fällen wurde eine Darmresektion mit primärer Anastomose, in 57 Fällen eine Diskontinuitätsresektion durchgeführt. Die postoperative Morbidität betrug insgesamt 44,7%, die Letalität 17,5%. Nach einzeitiger Resektion und Anastomose erhöhte ein Nikotinabusus (OR 4,2; p = 0,044), eine Hypalbuminämie (OR 4,0; p = 0,012), eine Kachexie (OR 3,9; p = 0,034), ein ASA-Score > 2 (OR 3,7; p = 0,030) und ein(e) Leberumbau/-zirrhose (OR 3,6; p = 0,031) das Risiko für postoperative Komplikationen. Die Hypalbuminämie (OR 1,8; p = 0,036), Kachexie (OR 1,8; p = 0,043), Anämie (OR 1,5; p = 0,038) und ein bekannter Alkoholabusus (OR 1,9; p = 0,023) wurden als unabhängige Risikofaktoren für die frühpostoperative Mortalität identifiziert. Nach Diskontinuitätsresektion führten eine Niereninsuffizienz (OR 2,1; p = 0,042) und Kachexie (OR 1,5; p = 0,045) zum signifikanten Anstieg des Risikos für die postoperative Morbidität, ein Alkoholabusus (OR 1,8; p = 0,041) für die Letalität. Eine Hypalbuminämie (OR 2,8; p = 0,019) und ein ASA-Score > 2 (OR 2,6; p = 0,004) steigerten nach Resektion und Rekonstruktion das Risiko für Majorkomplikationen entsprechend Clavien-Dindo, eine vorbestehende Niereninsuffizienz (OR 1,6; p = 0,023) das Risiko nach Diskontinuitätsresektion. In der univariaten Analyse wurden nach Tumorresektion und Rekonstruktion zusätzlich noch ein ASA-Score > 2 (p = 0,038), in beiden Gruppen mit und ohne primäre Anastomose eine dringliche Operation als signifikante Parameter mit Einfluss auf die Letalität ermittelt (p = 0,010 und p = 0,017). Schlussfolgerung Palliative Resektionen kolorektaler Karzinome haben eine hohe Morbidität und Mortalität. Bei vorbestehendem Alkoholabusus und dringlicher Operationsindikation sollte ein intensiveres Monitoring erfolgen. Bei Anämie, Kachexie, Hypalbuminämie sowie ASA-Score > 2 stellt möglicherweise die Diskontinuitätsresektion den geeigneteren Eingriff dar.

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How Should Surgical Palliative Success Be Defined?

Miller¹,

John

Ganai

2021

AMA Journal of Ethics

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Palliative surgery is often defined as surgical intervention with intent to improve a patient's quality of life by relieving suffering secondary to symptoms of advanced disease. In the context of shared decision making about palliative surgery intervention, tensions can arise between patient (or surrogate) and surgeon, who might not share goals and values. This article suggests that a surgeon's clinical and ethical duty is to identify goals of care, including those related to quality of life, from a patient's perspective and to consider how to achieve them. The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.Case "All I want from life is the opportunity to have sex with my wife, and without this," said Mr J, tearful and despondent, pointing to an ostomy appliance attached to his abdominal wall. Following initial diagnosis of rectal cancer several years ago, Mr J underwent chemoradiation followed by proctectomy and ileorectal anastomosis, with a "protective" diverting ileostomy to reduce risk of anastomotic leak. Mr J felt initially led to believe that the ileostomy was temporary. Despite assistance from enterostomal therapists, Mr J was extremely distressed about ostomy leakage during sex and felt dismissed when someone told him he needed to learn to live with it.After developing bilateral pulmonary metastases, Mr J chose to undergo palliative systemic chemotherapy. During that time, his disease remained stable, and he felt frustrated by not being able to convince his 2 prior surgeons to reverse his ileostomy. The first surgeon, Dr S, performed the protectomy and ileostomy and told Mr J that temporary suspension of chemotherapy to treat metastatic disease for the sake of reversing his ileostomy was not a good idea. After much discussion with Mr J, Dr S sympathized and sought to help Mr J adapt to life with the ileostomy but could not agree to reverse it. The second surgeon, Dr T, agreed with Dr S that there was no clinical indication to reverse his ileostomy, given that he was adequately hydrated and had no electrolyte imbalances, and agreed with Dr S that reversal would not be a good decision.

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Overview of Palliative Surgery: Principles and Priorities

Cited by 11 publications

References 26 publications

Palliative surgery in gastrointestinal malignancy: experience from a regional cancer centre

Palliative surgery in gastrointestinal malignancy: experience from a regional cancer centre

Palliativchirurgie beim kolorektalen Karzinom – welche Faktoren können bei der Wahl des operativen Vorgehens helfen?

How Should Surgical Palliative Success Be Defined?

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