Palliative surgery

Palliative surgery is defined as any invasive procedure with the major goal of relief of symptoms or to improve quality of life for patients with advanced illness. Palliative surgery is increasingly being recognized as important, in part, due to the significant frequency of inpatient palliative surgical consultations and palliative surgical procedures that surgeons are asked to perform. In addition, the morbidity and mortality associated with palliative surgery is higher than similar procedures performed in elective, non-palliative situations. Palliative care in surgery involves primarily two disciplines: communication and technical/clinical skills. Communication in palliative surgery incorporates the concepts of shared decision making and informed consent, difficult conversations in critically ill patients, and communication strategies for patients that want everything done in situations of medical futility. The specialty area of palliative surgery incorporating clinical and technical skills address the common indications for palliative surgical consultation such as gastrointestinal obstruction, gastrointestinal bleeding, wound problems, obstructive jaundice, and abdominal pain. Clinical trials are infrequent in palliative surgery and even prospective observational studies with patient reported outcomes are difficult to perform due to patient death and symptom burden that makes follow-up difficult. The focus of this review will primarily be on the clinical aspects of palliative surgery and the implications for future research and cancer policy. The purpose of this article will be to outline common indications for palliative surgical consultation, discuss treatment options, and summarize the research findings of variables associated with surgical intervention and outcome. In addition, we will highlight ongoing research projects that may help address the many questions regarding the optimal use of palliative surgery.