The role of surgery in the palliation of malignancy.

Surgery has always had an important role to play in the palliation of advanced malignancy and the advent of new techniques and procedures means that this role will continue to evolve. The field is not built on a strong evidence base, however, and the lack of consensus regarding definitions of palliative surgery and few validated outcome measures mean good prospective trials are difficult to carry out. In this review we propose a definition of palliative surgery from the literature and review the current role of surgical palliation in advanced malignancy. We discuss the central role of good decision-making and the influence of multidisciplinary working on this process. The barriers to carrying out research, both in surgery and in advanced cancer patient populations, are examined and the economic impacts considered.