Aggressive surgical palliation for advanced girdle tumours
Identifieur interne : 004522 ( Main/Curation ); précédent : 004521; suivant : 004523Aggressive surgical palliation for advanced girdle tumours
Auteurs : Andrew Burd [Hong Kong] ; K. C. Wong [Hong Kong] ; Shekhar M. Kumta [Hong Kong]Source :
- Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India [ 0970-0358 ] ; 2012.
Abstract
The surgical management of advanced, incurable, malignant disease presents particular ethical and technical challenges. The clear goal is palliation and the surgical futility must be avoided. This case series presents some particular challenges in end-of-life surgery.
Fifteen patients referred with advanced malignant disease involving a limb girdle were reviewed.
In one case, a patient pleaded for surgery after initially requesting a delay to seek treatment from a Chinese Traditional Herbalist. The increase in tumour bulk led to problems with surgery and the patient died in a hospital a few weeks later. This case illustrates ‘futility’ not recognized and encountered. The remaining 14 patients exhibited positive palliation with improved quality of dying and appreciation expressed by patients, relatives and staff.
In selected cases, with a skilled and experienced surgical team, patients with advanced malignant disease can still benefit from aggressive surgical palliation. The margin of error is small between palliation being attempted and futility being achieved. This considerably adds to the challenge of end-of-life surgery.
Url:
DOI: 10.4103/0970-0358.96571
PubMed: 22754147
PubMed Central: 3385388
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Wong</name><affiliation wicri:level="4"><nlm:aff id="aff2">Division of Orthopaedic Oncology, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong</nlm:aff><country xml:lang="fr">Hong Kong</country><wicri:regionArea>Division of Orthopaedic Oncology, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Kumta, Shekhar M" sort="Kumta, Shekhar M" uniqKey="Kumta S" first="Shekhar M." last="Kumta">Shekhar M. 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C." last="Wong">K. C. Wong</name><affiliation wicri:level="4"><nlm:aff id="aff2">Division of Orthopaedic Oncology, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong</nlm:aff><country xml:lang="fr">Hong Kong</country><wicri:regionArea>Division of Orthopaedic Oncology, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Kumta, Shekhar M" sort="Kumta, Shekhar M" uniqKey="Kumta S" first="Shekhar M." last="Kumta">Shekhar M. Kumta</name><affiliation wicri:level="4"><nlm:aff id="aff2">Division of Orthopaedic Oncology, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong</nlm:aff><country xml:lang="fr">Hong Kong</country><wicri:regionArea>Division of Orthopaedic Oncology, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author></analytic><series><title level="j">Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India</title><idno type="ISSN">0970-0358</idno><idno type="eISSN">1998-376X</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title><p>The surgical management of advanced, incurable, malignant disease presents particular ethical and technical challenges. The clear goal is palliation and the surgical futility must be avoided. This case series presents some particular challenges in end-of-life surgery.</p></sec><sec id="st2"><title>Materials and Methods:</title><p>Fifteen patients referred with advanced malignant disease involving a limb girdle were reviewed.</p></sec><sec id="st3"><title>Results:</title><p>In one case, a patient pleaded for surgery after initially requesting a delay to seek treatment from a Chinese Traditional Herbalist. The increase in tumour bulk led to problems with surgery and the patient died in a hospital a few weeks later. This case illustrates ‘futility’ not recognized and encountered. The remaining 14 patients exhibited positive palliation with improved quality of dying and appreciation expressed by patients, relatives and staff.</p></sec><sec id="st4"><title>Conclusion:</title><p>In selected cases, with a skilled and experienced surgical team, patients with advanced malignant disease can still benefit from aggressive surgical palliation. The margin of error is small between palliation being attempted and futility being achieved. 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