Authors' objectives:

The aim of this report was to assess the available literature on elective palliative procedures within the surgical specialities of gastroenterologic surgery, neurosurgery, thoracic surgery, urologic surgery and orthopedic surgery.

Authors' results and conclusions: Gastroenterological surgery: - Both stent and laser treatment give quick and palliative relief of symptoms from dysphagia in cancer of the oesophagus. Laser treatment often requires repeated sessions. Treatment with self expanding metal stents give significantly less complications than plastic tubes and has replaced the latter in clinical practice. - Treatment by stents and bypass surgery of obstructed bile ducts due to malignant disease give equal palliation of icterus and pruritus. Stent insertion appear to require less resources than surgical treatment. Randomized trials do not show any difference with regard to the rate of complications of the two methods. - When curative surgery is not feasible in gastric cancer, there is some evidence for supporting longer survival with resection of the stomach (including gastrectomy). - A large variation (40-80%) is observed in the control of symptoms related to surgical treatment of advanced cancer which cause obstruction of the ileus. - Treatment by laser, stent or cryotherapy of obstruction or haemorrhage of the lower part of the colon or rectum are treatment modalities that can give effective palliation when surgery is not possible or as an alternative to surgery. Neurological surgery: - Cytoreductive surgery is superior to biopsy in improving quality of life and survival in intracranial cancer such as glioma. - Surgery of metastases to the brain is useful in patients with single metastasis and otherwise stable cancer disease. Orthopedic surgery: - Metastases to the long bones and hip bone may require surgery to relieve severe pain and maintain function. This demands surgical stabilization and the need for immediate functionality independent of bone healing. - Surgical treatment of metastases to the back is required to make support at a site of fracture and when pain relief has not been achieved with radiation treatment. - Laminectomi is not adviced unless the column is stabilized. Thoracic surgery: - Increased length of survival can be achieved in surgical removal of metastases from primary cancers of other organs. Best results are achieved with metastases from cancer of the testis and soft tissue carcinomas, but aceptable results are also achieved in cases of hard tissue carcinomas. - Pain, obstructed breathing and infection can be prevented by treating the obstruction caused by cancer of the central airways. Mode of treatment is by laser or stenting. - Cerebral symptoms and symptoms of localized pressure caused by tumor growth obstructing the superior vena cava can be prevented and treated. Mode of treatment is thrombolysis, blocking or stenting of the vein. Urological surgery: - The most common treatment of local symptoms such as haemorrhage and obstruction due to cancer of the prostate and bladder is transurethral resection (TUR) of the prostate and the bladder. The use of stent is a good alternative to TUR or catheter in waiting for the effect of hormonal treatment on the obstruction to take place. - Local symptoms of haemorrhage from the bladder is most commonly treated by TURB. An alternative if the hamorrhage does not stop, is to rinse the bladder with a solution of aluminium. - Adequate documentation support the embolizing of the kidney artery in persisting haemorrhage and radiating pain due to cancer of the kidney. This form of treatment has virtually replaced the conventional operation of nephrectomy. - The chosen treatment of malignant obstruction of the ureter is now the minimally invasive technique of pecutaneous nephrostomy or internal ureter stent. The effect of these methods are very well documented and this treatment has practically replaced larger operations.

Authors' recommendations: Lack of well designed and completed clinical studies is a matter of concern regarding the scientific basis for treatment within the field of palliative surgery. While some procedures and a few clinical problems have been focused in prospective (randomized) studies, many common clinical problems and challenges seem to be solved based on limited scientific documentation. In spite of the difficult situation for many patients with advanced malignant disease, it seems possible and necessary to improve our research efforts to provide useful documentation of effects related to palliative surgical procedures. Controlled studies should be performed when possible. Since palliative cancer surgery demands a major part of the resources in cancer care, all procedures registered ought to be coded as being palliative or curative. This combined with information reported to the Cancer Registry would give us new possibilities in assessing both effects and costs related to cancer surgery.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nokc.no/

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Norway

Organisation Name: Norwegian Institute of Public Health

Contact Address: Universitetsgata 2, Postbox 7004 St. Olavs plass, NO-0310 Oslo NORWAY. Tel: +47 23 25 50 00; Fax: +47 23 25 50 10;

Contact Name: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Contact Email: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Copyright: The Norwegian Knowledge Centre for the Health Services