Aborted cancer surgery at a single tertiary cancer center: Rates, reasons, and outcomes

Abstract

BackgroundSurgical resection is typically necessary for curative-intent treatment of most solid organ cancers. However, even with meticulous preoperative evaluation, operative procedures are occasionally aborted. The incidence, outcomes, and long-term prognoses of aborted cancer surgery have not been thoroughly investigated. MethodsAll oncologic operations performed at a single tertiary cancer center between 2011–2021 were retrospectively queried; natural language processing of operative reports was used to identify aborted cancer surgeries. Surgical indications, clinicopathologic characteristics, short- and long-term outcomes, and palliative care involvement were retrospectively reviewed from the electronic medical record. ResultsOverall, 345 patients underwent aborted cancer surgery for a rate of 36 patients per year. The most common cancers were pancreatic (28%), biliary (14%), and colorectal (9%). The most commonly aborted operations were pancreatoduodenectomy (34%) and hepatectomy (22%). Most operations were aborted due to unanticipated tumor unresectability (47%) and occult metastatic disease (43%). Sixty percent of patients returned to cancer-directed therapy; 9% underwent successful reattempt at resection. The median overall survival of all patients after aborted surgery was 13.6 months (95% confidence interval, 11.2–16.0 months). Those who returned to oncologic therapy had longer survival (18.6 months vs 5.4 months, P < .001). Palliative care consultation was received by 34% and 13% of patients overall and within 30 days of surgery, respectively. ConclusionAborted cancer surgery was associated with poor outcomes, particularly in patients with aggressive cancer types and those who did not receive further cancer-directed therapy. Future studies should identify interventions such as palliative care consultation that may improve patient-centered outcomes.