Surgical palliation at a cancer center - Incidence and outcomes

Hypothesis: Surgical intervention in palliative care is common; however, th e indications, risks, and outcomes are not well described. Design: Retrospective review of surgical cases during a 1-year period with a minimum 1-year survival update. Setting: A National Cancer Institute-designated comprehensive cancer center . Patients: Patients with a cancer diagnosis undergoing operative procedures. Main Outcome Measures: Number of palliative surgeries and analysis of lengt h of stay, morbidity, and mortality. Results: Palliative surgeries comprised 240 (12.5%) of 1915 surgical proced ures. There were 170 major and 70 minor procedures. Neurosurgical (46.0%), orthopedic (31.3%), and thoracic (21.5%) surgical procedures were frequentl y palliative. The most common primary diagnoses were lung, colorectal, brea st, and prostate cancers. Length of hospital stay was 12.4 days (range, 0-9 9 days), with 21.3% of procedures performed on an outpatient basis. The 30- day mortality was 12.2%, with 5 patients dying within 5 days of their proce dure. The overall mortality was 23.3% (56/240). Mortality for surgical proc edures classified as major was 21.9% (44/170) and 10.0% (7/70) for those cl assified as minor (Fisher exact test, P<.01). Conclusions: Significant numbers of palliative procedures are performed at our cancer center. Overall morbidity and mortality were high; however, a si gnificant number of patients had short hospital stays and low morbidity. Pa lliative surgery should remain an important part of end-of-life care. Patie nts and their families must be aware of the high risks and understand the c lear objectives of these procedures.