The palliative triangle: improved patient selection and outcomes associated with palliative operations.

OBJECTIVES

To examine the outcomes of patients managed with the palliative triangle method and to evaluate factors associated with effective patient selection.

DESIGN

Patients receiving a procedure to palliate symptoms of advanced cancer were identified prospectively from all surgical palliative care consultations and observed for at least 90 days or until death.

SETTING

Academic surgical oncology service.

PATIENTS

A total of 227 patients symptomatic from advanced incurable cancer.

INTERVENTION

The palliative triangle technique was used to select patients for palliative operations.

MAIN OUTCOME MEASURES

Symptom resolution, overall survival, and complications.

RESULTS

We evaluated 227 patients from July 1, 2004, through June 30, 2009. Reasons cited for not selecting 121 patients (53.3%) for a palliative procedure were low symptom severity (23.9%), decision for nonoperative palliation (19.0%), patient preference (19.8%), concerns about complications (15.7%), and other (21.6%). A palliative operation was performed in 106 patients (46.7%) for complaints of gastrointestinal obstruction (35.8%), local control of tumor-related symptoms (25.5%), jaundice (10.4%), and other (28.3%). Of these 106 patients, 5 required procedures for recurrent symptoms and 6 for additional symptoms; of the 121 patients originally not selected, 12 required procedures for progressive symptoms, for a total of 129 procedures. Patient-reported symptom resolution or improvement was noted in 117 of 129 procedures (90.7%). Palliative procedures were associated with 30-day postoperative morbidity (20.1%) and mortality (3.9%). Median survival was 212 days.

CONCLUSION

Palliative operations performed in these carefully selected patients were associated with significantly better symptom resolution and fewer postoperative complications compared with previously published results.