Palliative Gastrointestinal Surgery in Patients With Advanced Peritoneal Carcinomatosis: Clinical Experience and Development of a Predictive Model for Surgical Outcomes

Definition of Palliative Surgery in Cancer Care: A Systematic Review

Palliative surgery is commonly performed in cancer centers worldwide. Yet, there is little agreement on the definition of palliative surgery or its relevant outcomes. This systematic review sought to characterize the definitions of palliative surgery and outcomes for patients with cancer undergoing thoraco-abdominal procedures. Following PRISMA guidelines, we conducted a search using PubMed, EMBASE and CINAHL databases to identify English-language publications between August 1, 2005, and December 31, 2023 reporting palliative thoraco-abdominal procedures for patients with cancer. Definitions of palliative surgery were coded and analyzed using an inductive approach. Outcomes were classified according to an outcome measures hierarchy. Among 92 articles met inclusion criteria and four themes emerged in how palliative surgery was defined throughout the literature: prognosis (incurable cancer diagnosis), purpose (intent to treat symptoms or improve quality of life), procedure type (specific operative interventions), or persistent disease following surgery (incomplete cytoreduction). Survival (90%) and perioperative complications/morbidity (72%) were the most commonly reported outcomes, whereas symptom relief, quality of life, and sustainability of success were infrequently reported. Definitions of palliative surgery vary across studies of patients with cancer undergoing thoracic or abdominal procedures and measured outcomes often do not align with the intent of surgery.

Trajectories of Patient-Reported Outcomes After Palliative Gastrointestinal Surgery in Advanced Cancer: Is Good Quality of Life Sustainable?

To evaluate the trajectories and sustainability of health-related quality of life (HRQoL) outcomes after palliative gastrointestinal (GI) surgery and perioperative factors associated with HRQoL improvement postsurgery.

Background

Palliative patients face a wide range of physical, emotional, social, and functional challenges. In evaluating the efficacy of palliative surgical interventions, a major pitfall of traditional surgical outcome measures is that they fall short of measuring outcomes that are meaningful to patients during end-of-life. HRQoL tools may provide a more comprehensive assessment of the true value and impact of palliative surgery.

Methods

We prospectively recruit advanced cancer patients undergoing palliative GI surgery. The Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire was administered before and at regular intervals after surgery. HRQoL improvement was defined as ≥4-points increment in FACT-G total score over baseline. Duration of sustained HRQoL improvement above this threshold and factors associated with varying extents of HRQoL change were evaluated.

Results

Of the 65 patients, intestinal obstruction was the most common indication for surgery (70.8%). The mean baseline FACT-G total score was 70.7 (95% CI: 66.3-75.1). Forty-six (70.8%) patients experienced HRQoL improvement after surgery. This HRQoL improvement was sustained over a median duration of 3.5 months and was driven mainly by improvements in patients' physical and emotional well-being. Albumin was significantly associated with the extent of HRQoL improvements (P = 0.043).

Conclusion

A clinically significant and sustained improvement in HRQoL was observed after palliative GI surgery. Patients with higher preoperative albumin levels were more likely to experience HRQoL improvements.