Palliative gastrointestinal surgical oncology-outcomes after palliative care consultation: retrospective observational study

BMJ Support Palliat Care. 2023 Feb 28:spcare-2022-004045. doi: 10.1136/spcare-2022-004045. Online ahead of print.


Objectives: Palliative surgery aims to relieve patients' symptoms and improve quality of life with surgical interventions. While a multidisciplinary approach has been found beneficial for critically ill patients, limited evidence supports this approach in palliative surgery. Here we sought to study whether palliative care consultations can improve outcomes among patients undergoing palliative surgery.

Methods: Consecutive patients undergoing palliative care at gastrosurgical wards in a tertiary Finnish university hospital during a 2-year study period were included. Outcomes of those undergoing surgery with or without palliative care consultation were compared. The main outcome measures were patients' functional status, postoperative morbidity and mortality.

Results: A total of 312 patients were included, of whom 173 underwent surgery, 77 endoscopic care and 62 were treated conservatively. Of the operated patients, 24 underwent multidisciplinary assessment while among the rest, the treatment decision was based on the surgeons' assessment. Multidisciplinary assessment was associated with a clinically significantly reduced morbidity (8.3% vs 23%, p=0.111), in-hospital mortality (8.3% vs 17%, p=0.051) and rate of hospital readmissions (8.3% vs 21%, p=0.052). There was no difference in median survival 49 (2-440) vs 45 (1-971) days (p=0.949). Of those undergoing conservative care, 44% could have undergone surgery.

Conclusions: The aim of the palliative surgery is to relieve symptoms among patients with no hope of being cured. While the involvement of the palliative care consultation into the surgical decision-making is likely to reduce unnecessary operations, it is likely to be even more important in improving quality of end-of-life care.

Keywords: End of life care; Gastrointestinal (lower); Gastrointestinal (upper); Pancreatic; Supportive care.