The Role of Surgery in the Palliative Care of Cancer: A Retrospective Analysis of 22 years

Abstract

Aim: Surgical procedures in palliative care are common, however the indications, risks and outcomes are not well described. We present a retrospective review of the management of cancer patients. Material and Methods: During the period 2000-2022, 11.700 of cancer cases (abdominal, gynecological, urological and breast) were recorded in our registries and are analyzed. Group A: All 6000 patients (51,3%) included in this group had a therapeutic intent in their management which include surgical procedures ± neoadjuvant and systemic chemotherapy and radiotherapy. Group B: Palliative approach was applied in 2650 cases (22,6%) with both surgical and medical management being performed. Medical management consists of systemic chemotherapy and radiotherapy. Surgical procedures for palliation, include resections, reconstructions, ostomies, functional repairs, tube drainage and biopsies. Group C: Best supportive care was applied in 3050 cases (26,1%) which includes nutritional management with home parenteral or enteral nutrition, pain management, physical and respiratory physiotherapy, and fistulas or ulcers management. Primary end points include survival advantages while Quality of Life (QOL) was set as a secondary benefit. The risk of morbidity and treatment related mortality are also calculated between the different groups. Results: A median follow up of 80 months was observed. The median O.S. for group A was 44,4 ± 16,3 months and for palliative care group (B) was 26,3+11,7 m (p<0,01). On the other hand, the median O.S. for the group C (Best supportive care) was 8,7 ± 5,2 m. More specifically the group of patients with peritoneal metastasis which include 5200 patients (44,5%) of the total cancer patients was subdivided in 4 subgroups. The role of palliative surgery with or without systemic or neoadjuvant chemotherapy, offer a better O.S. when compared with only systemic chemotherapy (13,4 ± 7,5 m vs 71 ± 4,3 m) with acceptable morbidity and mortality rates. Conclusion: In conclusion, the need for holistic palliative care in cases of incurable malignancy is not entirely clear how it is best to integrate into palliative surgical principles. The essential roles of surgical palliation are, initial evaluation of the disease, local control, control of discharge or hemorrhage, control of pain and reconstruction and rehabilitation