The Role of Palliative Surgery in Gynecologic Cancer Cases

Abstract

The decision to undergo major palliative surgery in end-stage gynecologic cancer is made when severe disease symptoms significantly hinder quality of life. Malignant bowel obstruction, unremitting pelvic pain, fistula formation, tumor necrosis, pelvic sepsis, and chronic hemorrhage are among the reasons patients undergo palliative surgeries. This review discusses and summarizes the literature on surgical management of malignant bowel obstruction and palliative pelvic exenteration in gynecologic oncology. TheOncologist2013;18: 73-79Implications for Practice: The decision to perform palliative surgery in gynecologic oncology is difficult. This review discusses the currently available data for the surgical management of malignant bowel obstruction and palliative pelvic exenteration. While there are no effective parameters to determine which patients will benefit from palliative surgery, surgery should be considered when severe disease symptoms hinder the quality of life.

Total or Subtotal Colectomy in Patients Undergoing Surgery for Primary or Recurrent Epithelial Ovarian Cancer

“…Palliative surgery due to acute bowel obstruction is an acknowledged option if there are no further life-limiting lesions and a survival benefit can be expected. However, a high rate of severe complications with a morbidity of 5-49% and a mortality of 5-15% are to be expected [26]. It is important to point out that in the studies on debulking procedures summarized in the meta-analysis by Hope and Pothurino [26], no total colectomies were performed.…”

“…However, a high rate of severe complications with a morbidity of 5-49% and a mortality of 5-15% are to be expected [26]. It is important to point out that in the studies on debulking procedures summarized in the meta-analysis by Hope and Pothurino [26], no total colectomies were performed. Overall survival has not been addressed in ovarian cancer in prospective studies.…”

“…In addition, palliative surgery to correct a large bowel obstruction in patients with ovarian cancer may result in colon resection. In a recent review of 17 publications on this surgical procedure, a morbidity of 5-49% and a mortality of 5-15% were reported [26]. Extensive mesenteric disease can make bypassing impossible so that extensive resection of the intestine becomes necessary.…”

Significant Reduction in Deaths in Hospital Over a Decade in an Increasingly Elderly Population Dying From Pelvic Cancer in England: A Population Based Study

“…The complications experienced by patients dying from end stage pelvic cancers have been well documented and often necessitate hospital management which may increase the patient's chance of dying in hospital [10][11][12][13]. The National Institute for Health and Care Excellence (NICE) in England has included specific guidance for the management of end stage pelvic cancers in their guidelines [22,23].…”

“…These may necessitate surgical interventions from multiple subspecialties often working together in the management of patients [10,11]. These complications are likely to lead to multiple hospital admissions requiring a range of interventions [12,13], increasing the likelihood of patients dying in hospital.…”