Palliative surgery for advanced cancer - Lessons learned in patient selection and outcome assessment

被引:34
作者
Miner, TJ [1 ]
机构
[1] Brown Med Sch, Rhode Isl Hosp, Director Surg Oncol, Dept Surg, Providence, RI 02903 USA
来源
AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS | 2005年 / 28卷 / 04期
关键词
surgical palliation; advanced cancer; surgical decision-making;
D O I
10.1097/01.coc.0000158489.82482.2b
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Introduction: When considering the appropriate and effective,e of palliative procedures, a surgeon is often confronted with a I 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.
引用
收藏
页码:411 / 414
页数:4
相关论文
共 28 条
[11]   A MULTICENTER EVALUATION OF THE MCGILL PAIN QUESTIONNAIRE - RESULTS FROM MORE THAN 1700 CHRONIC PAIN PATIENTS [J].
HOLROYD, KA ;
HOLM, JE ;
KEEFE, FJ ;
TURNER, JA ;
BRADLEY, LA ;
MURPHY, WD ;
JOHNSON, P ;
ANDERSON, K ;
HINKLE, AL ;
OMALLEY, WB .
PAIN, 1992, 48 (03) :301-311
[12]   ''Routine'' preoperative studies - Which studies in which patients? [J].
Marcello, PW ;
Roberts, PL .
SURGICAL CLINICS OF NORTH AMERICA, 1996, 76 (01) :11-&
[13]   Decision making in palliative surgery [J].
McCahill, LE ;
Krouse, RS ;
Chu, CZJ ;
Juarez, G ;
Uman, GC ;
Ferrell, BR ;
Wagman, LD .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2002, 195 (03) :411-422
[14]  
Miner Thomas J, 2004, Surg Oncol Clin N Am, V13, P455, DOI 10.1016/j.soc.2004.03.004
[15]   A prospective evaluation of patients undergoing surgery for the palliation of an advanced malignancy [J].
Miner, TJ ;
Jaques, DP ;
Shriver, CD .
ANNALS OF SURGICAL ONCOLOGY, 2002, 9 (07) :696-703
[16]   Decision making on surgical palliation based on patient outcome data [J].
Miner, TJ ;
Jaques, DP ;
Tavaf-Motamen, H ;
Shriver, CD .
AMERICAN JOURNAL OF SURGERY, 1999, 177 (02) :150-154
[17]   Defining palliative surgery in patients receiving noncurative resections for gastric cancer [J].
Miner, TJ ;
Jaques, DP ;
Karpeh, MS ;
Brennan, MF .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2004, 198 (06) :1013-1021
[18]   Symptom control in patients with locally recurrent rectal cancer [J].
Miner, TJ ;
Jaques, DP ;
Paty, PB ;
Guillem, JG ;
Wong, WD .
ANNALS OF SURGICAL ONCOLOGY, 2003, 10 (01) :72-79
[19]   A prospective, symptom related, outcomes analysis of 1022 palliative procedures for advanced cancer [J].
Miner, TJ ;
Brennan, MF ;
Jaques, DP .
ANNALS OF SURGERY, 2004, 240 (04) :719-726
[20]  
MINER TJ, 1998, BREAST, V4, P84