Principles and Potential of Palliative Surgery in Patients with Advanced Cancer

Abstract

Although the majority of patients with advanced cancer are unlikely to be cured, recurrent or metastatic disease does not have to mean that a rapid or painful death is imminent. Palliative surgery aims to improve patients’ quality of life without necessarily removing all tumor, as when malignancy is advanced there is less emphasis on specific tumor therapy and more on supportive care. Palliative surgery should be seen in this context — as a part of overall patient management aimed at reduction of symptoms and prolongation of useful life without curative intent. Palliative surgery for advanced cancer should follow sound principles of surgical oncology. These involve preoperative, operative, and postoperative patient care as well as surgery of particular complications. It must be remembered that patients with cancer might also have a nonmalignant surgical problem such as appendicitis that can be readily corrected, and this dictates that a careful, rapid, and thorough assessment be made to allow early aggressive and definitive surgery to be undertaken. It should never be assumed that a new clinical problem in a cancer patient is certainly due to the cancer. This is bad medicine and the basis of unnecessary suffering and mortality.