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2010 Annual Meeting Abstracts

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The Palliative Triangle: Better Patient Selection Improves Outcomes Following Palliative Operations
Thomas J Miner, *Jonah Cohen, *Jane McPhillips, *Lauren Marvell, *Carmen Dachuna, William G Cioffi
Brown University, Providence, RI

Objective: The appropriate use of surgical procedures to palliate symptoms caused by advanced malignancies requires the highest level of surgical judgment. Techniques to improve clinical decision making and patient selection are needed to improved outcomes.
Design: Patients receiving a procedure to palliate symptoms of advanced cancer were identified prospectively from all surgical palliative care consultations and observed for >90 days or until death.
Setting: Academic Surgical Oncology Service
Patients: Symptomatic from advanced incurable cancer
Interventions: All patients were evaluated using the previously described palliative triangle technique. During this process the patient’s complaints, values, and support systems are considered against known medical and surgical alternatives. Constructive interactions between the patient, family members, and the surgeon are facilitated to promote effective decision making.
Main Outcome Measures: Symptom resolution, overall survival, complications
Results: 227 patient evaluations were performed from July 2004 to June 2009. A palliative operation was performed in 47% (106/227) for complaints of gastrointestinal obstruction (39%), local control of tumor related symptoms (24%), jaundice (8%), and other (29%). Patient reported symptom resolution was noted in 92% (97/106). Palliative procedures were associated with 30-day postoperative morbidity (19%) and mortality (4%). Median survival was 212 days. Reasons cited for patients not being selected for a palliative procedure (53%, 121/227) were low symptom severity (24%), decision for non-operative palliation (19%), patient preference (14%), concerns over complications (12%) and other (31%).
Conclusions: The dynamic interaction between patient, family, and surgeon mandated by the palliative triangle technique helps guide optimal decisions regarding surgical palliation for the individual patient. Operations performed in these carefully selected patients were associated with significantly better symptom resolution and decreased postoperative complications compared to previously published results.

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