Palliative surgery for advanced cancer: lessons learned in patient selection and outcome assessment.

INTRODUCTION: When considering the appropriate and effective use of palliative procedures, a surgeon is often confronted with a full range of multidisciplinary treatment options and technical considerations that could potentially relieve some of the symptoms of an advanced malignancy. Practitioners must often deliberate over complex choices that can greatly impact a patient's final days.
METHODS: Advances in the understanding of surgical palliation are reviewed with emphasis on elements required for sound clinical decision making.
RESULTS: Palliation of complications from advanced cancer demands the highest level of surgical judgment. Although consideration of risk in terms of treatment-related toxicity, morbidity and mortality is an important part of the surgical decision making process. Attention to this element should not be the sole factor in making decisions about palliative therapy. Decisions are best made on endpoints such as the probability of symptom resolution, the impact on overall quality of life, pain control, and cost effectiveness.
CONCLUSIONS: Regardless of the anatomic site and cause leading to the need for palliative intervention, deliberations over surgical palliation must consider the medical condition and performance status of the patient, the extent and prognosis of the cancer, the availability and success of nonsurgical management, and the individual patient's quality and expectancy of life. Therapy for symptoms must remain flexible and individualized to continually meet the patient's unique and ever changing needs.