Surgery to relieve distressing symptoms in an individual with no hope of cure or intent to lengthen their lifespan is considered palliative.2 Five main purposes have been described for palliative surgical procedures:11
- evaluation of the extent of the disease
- control of locoregional spread
- control of a fungating tumour, discharge or haemorrhage
- control of pain
- surgical reconstruction or rehabilitation to improve quality of life.
Examples of palliative interventions include:2
- neurolytic blockade of the mandibular or sphenopalanine nerves in head and neck disease
- radical mastectomy or surgical debulking for a fungating malodorous breast lesion
- salvage cystectomy or pelvic exenteration for advanced prostate or cervical cancers
- insertion of a self-expanding vascular stent for the alleviation of spinal cord compression and superior vena cava obstruction.
The decision-making process involves identifying goals, recognising values, acknowledging alternatives, and weighing risks and burdens.12 Good communication is vital and SCNs have a valuable role in information provision and supportive care.2, 13 Challenges identified by clinicians in this field include maintaining hope in the face of communicating an honest assessment of the person's health status.12
Describe clinical examples of the use of palliative surgery for:
- Control of locoregional spread
- Control of a fungating tumour
- Control of haemorrhage
- Control of pain
Access the article Patient and surgeon decision making regarding surgery for advanced cancer12. Review Figure 1: Clinical decision making in palliative surgery, and discuss how this conceptual model can be used in practice to support people affected by cancer considering palliative surgery.