Anke M Mols, Department of Surgery, Kantonsspital Olten, Switzerland, explains the background to her longer article that is published today in the ‘European Journal of Palliative Care’.
I was asked to write about how I became interested in ‘palliative surgery’. During my years in surgical training I experienced quite a few times that patients were sent to us from the department of oncology with the request to operate. These were highly symptomatic patients in a purely palliative situation because of tumour progress and, for example, obstruction of viscera by tumour burden. And I noticed several things:
First of all, I saw that this is where evidence-based medicine ends. We have evidence-based findings in almost all areas of surgery: how large does a mesh have to be for inguinal hernia repair, when do we have to operate on diverticulitis and which antibiotics do we give before we perform an appendicectomy? We, the surgeons and the oncologists, do not have data about the outcomes of surgery in palliative situations, the potential of solving very distressing symptoms and the risk of creating even more suffering by operations. Furthermore, there is no data about operative techniques in these special cases.
I am still not sure. Probably this is the right way to come to individualised decisions in difficult palliative situations. Still, I find it frustrating to have no data, because consequences are so immediate and of such great impact on our patients.
My second observation was that in all cases the decision making was very reflected and reasoned. Doubts were allowed and the situation discussed with the patient. All clinicians tried to put the patient at the centre of the debate. Even though I had many positive experiences, my wish was to study the data to back up those very important decisions – as we are used to in all other fields of surgery.
We will probably never have a nice formula, in which we can put risks factors such as type of tumour, time since first diagnosis, grade of malnutrition, age, gender, etc, and calculate exactly the risks for surgery and probable outcome. But I think we should be able, as clinicians and as surgeons, to give well-grounded advice in those very problematic situations, where surgery might help relieve severe symptoms.
Find out more…
The article to which this post relates, ‘Palliative surgery in cancer patients: what do we know about it?’, by AM Mols, S Reiter-Theil, D Oertli, and CT Viehl, is published in the January/February 2013 issue of the ‘European Journal of Palliative Care’ (volume 20, number 1).
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