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What is Palliative surgery?

What is palliative surgery?

Palliative surgery  a surgery performed to relieve the distressing symptoms and issues caused by advanced cancer without curative intent. According to Dr. Svs Deo of the Indian Journal of Palliative Care mentions advanced cancers have put a significant burden on developing countries which is why palliative cancer surgery has played a crucial role in overall cancer and pain management.

Palliative care surgery is a surgical practice aimed at providing pain relief for the patient with advanced disease, according to the National Cancer Institute (NCI). The NCI, under the National Institutes of Health, is a federal agency that is tasked to disseminate information about cancer and cancer research. Terminal cancer patients benefit from a wide range of palliative care surgeries by not only making their lives comfortable but also prolonging their lives and addressing symptom control and symptom relief.

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What is an example of a palliative surgery?

An example of a palliative care surgery, as mentioned by the NCI, is a nerve block procedure. A nerve block procedure is done to interrupt pain signals in the nervous system. Dr. Christine Glaser from the University of Pittsburgh defines a nerve block as a surgical procedure that uses a needle or device to deliver an analgesic medication.

A study published in the British Journal of Anaesthesia states that 2-10% of patients can benefit from nerve blocks. Nerve blocks have several varieties, according to Dr. William Alastair Chambers of Aberdeen University. The first variety is the central neuraxial blocks. Central neuraxial blocks or intraspinal blocks use epidural analgesia and intrathecal infusions. Epidural analgesia delivers drugs through a catheter into a space outside the spinal cord. Intrathecal infusion is administered by injecting drugs into the spinal canal.

Peripheral nerve blocks or plexus blocks involve injecting local anesthetics near the major nerves or peripheral nerves. Dr. Chambers sites the different peripheral nerve blocks that have been reported by experienced surgeons for surgery, postoperative pain, chronic pain syndromes, and other treatments. These include the following such as femoral nerve block, sciatic nerve block, paravertebral, brachial plexus block, suprascapular, psoas compartment, distal lumbar plexus, and intrapleural blocks.

Sympathetic blocks or autonomic blocks target a specific body region. Examples of sympathetic blocks are celiac plexus block for upper abdomen pain, superior hypogastric block for pelvic and urogenital pain, splanchnic nerve block for metastatic disease of the abdomen, and ganglion impar block for rectal and perineal pain.

Dr. Glaser identifies the side effects and complications of nerve blocks. These are procedural pain, infection, bleeding or hematoma, and nerve damage. Sympathetic blocks can cause orthostatic hypotension, transient diarrhea, and hiccups. Central neuraxial blocks can cause technical problems such as catheter dislodgement and pump malfunction. Peripheral nerve blocks can cause painful neuritis and paresthesia.


Does palliative care involve surgery?

Yes, palliative care services involve surgery. Dr. Elizabeth Lilley and others, in their article published in the Journal of Palliative Medicine, mention the statement of palliative care in surgery of the American College of Surgeons (ACS). The ACS recognizes the role of palliative care in managing surgical patients with serious illnesses.

Dr. Lilley and others add that palliative surgical procedures are aimed at reducing suffering and supporting quality of life instead of treating the disease or prolonging the life of patients with cancer. On the other hand, studies have described the risks of postoperative complications and mortality after palliative surgery. In addition, the impacts of palliative surgery on restoring function and quality of life are measured by only a few.


What is the survival rate for palliative surgery?

A study published by Dr. Ridho Ardhi Syaiful and others in the Journal of the Pancreas measures the survival rate for palliative care surgery. Palliative care surgery is the main curative treatment option for advanced periampullary cancer. The results of the study show a 19 percent one-year survival rate and an 88 percent 30-day survival rate for palliative surgery patients. The low 30-day mortality rate implies that palliative care surgery is a safe procedure.

Dr. Robert Krouse and others measured the mortality rate of palliative surgeries during a 1-year period in their article published in the Journal of American Medical Association. The most common palliative care surgical procedures were neurosurgical, orthopedic, and thoracic. Results show a 12.2 percent 30-day mortality and 23.3% overall life expectancy. This shows the importance of palliative care surgery in end-of-life care, according to Dr. Krouse and others.


Is there palliative surgery for congenital heart disease?

Yes, there is palliative surgery for congenital heart disease. Congenital heart disease palliative surgical interventions are aimed at improving heart function and minimizing disorders for children who are too young to undergo corrective surgical practice.

Dr. Shi-Min Yuan and others identified a wide range of 21 palliative procedures that are categorized into four classes based on goals and indications. The first class is increasing pulmonary artery flow for pulmonary oligaemia. The second palliative major procedure is decreasing pulmonary artery flow for pulmonary over circulation. The third class is enhancing intracardiac blood-oxygen mixture for systemic hypoxaemia. And the last class includes other surgical techniques such as congenital mitral or aortic stenosis palliation, coarctation of aorta palliation, and hybrid palliative procedures for hypoplastic left heart syndrome (HLHS).


Is there palliative surgery for colon cancer?

Yes, there is palliative surgery for colon cancer. Dr. Alexander Beham and others published an article in the World Journal of Gastroenterology about the survival benefit of colon cancer patients after palliative care resection surgery. A colon resection surgery is an operation to remove a part or all of the colon. Results show that palliative care resection surgery for primary colorectal cancer is associated with a high survival rate. A poor survival rate is associated with the presence of liver metastasis and tumor size. Bleeding and intestinal obstruction are the main symptoms of patients with palliative care surgical intervention.

On the other hand, Dr. Sean Judge and others, in their article published in the Frontiers of Oncology journal, argue that palliative care surgery in metastatic colorectal cancer has remained controversial. It has been controversial because of a narrow risk-to-benefit ratio with the potential of significant postoperative morbidity and life expectancy. This can impact the quality of life, performance status, and tolerability of additional anti-cancer therapies such as cytotoxic chemotherapy. The most common palliative intervention for advanced colorectal cancer is stoma creation. Stoma creation is used to relieve malignant bowel obstructions, intestinal obstructions, and other associated symptoms.

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