Palliative surgery

B25. Bernhard, W. F., Somers, L. A., Kriek, H. R., and Tadaaki, A., Corrective and palliative surgery in infants and children with congenital heart disease. In Clinical Application of Hyperbaric Oxygen (I. Boerema, W. H. Brummelkamp, and N. G. Meijne, eds.), pp. 189-193. Elsevier, Amsterdam, 1964. 

In the veterinary as in the human patient, neoplasms are often metastatic and widely disseminated throughout the body. Surgery and irradiation are limited in use to weU-defined neoplastic areas and, therefore, chemotherapy is becoming more prevalent in the management of the veterinary cancer victim (see Chemotherapeutics, anticancer). Because of the expense and time involved, such management must be restricted to individual animals for which a favorable risk—benefit evaluation can be made and treatment seems appropriate to the practitioner and the owner. In general, treatment must be viewed not as curative, but as palliative. 

Cancer or neoplastic disease is a genomic disorder of the body s own cells which start to proliferate and metastasize in an uncontrolled fashion that is ultimately detrimental to the individual. Antineoplastic agents are used in conjunction with surgery and radiotherapy to restrain that growth with curative or palliative intention. The domain of antineoplastic chemotherapy is cancer that is disseminated and therefore not amenable to local treatment modalities such as surgery and radiotherapy. 

Obviously, this broad range of tumor extent requires an equally broad array of treatment approaches, ranging from surgery, with or without adjuvant radiation therapy (RT) or chemotherapy (ChT), to definitive chemoradiation combinations, to palliative... 

Although radiation alone has been utilized historically in the treatment of medically inoperable esophageal cancers and continues to be used today in the palliative setting, the standard of care for the nonsurgical management of localized esophageal cancer remains concurrent chemoradiation. For those patients who are unable to tolerate surgery or... 

In a second randomized study of postoperative radiation (4900 cGy curative resection and 5250 cGy palliative resection, 350 cGy/fraction) vs surgery alone, the median survival was shorter for the radiated arm (8.7 mo vs 15.2 mo). The authors attributed the shorter survival of the postoperative radiation arm to irradiation-related deaths (23). Local recurrence was significantly reduced in the patients who received radiation following palliative resection (20% vs 46%, p = 0.04), but no difference in local recurrence was noted in the patients resected for cure. 

The only potentially curative treatment modality for localized gastric cancer is surgery however, overall 5-yr survival rate often does not exceed 40%. Patients having unresectable localized gastric cancers but no evidence of metastatic disease can be expected to survive 5-6 mo. Palliative measures for advanced gastric cancer can include... 

IIIB Palliative chemotherapy, radiotherapy +/- surgery, neoadjuvant chemoradiation... 

Ketoconazole can be used as palliative treatment for Cushing s syndrome in patients undergoing surgery or receiving pituitary radiation and in those for whom more definitive treatment is still contemplated. Because surgical treatment is not always well tolerated by elderly patients, ketoconazole 200 to 1,000 mg/day can be a valuable alternative for the control of hypercortisolism. Common side effects include pruritus, fiver dysfunction, and gastrointestinal symptoms. 

Bleomycin is used as palliative and adjuvant to surgery and radiation therapy in... 

Tumors that are steroid hormone-sensitive may be either (1) hormone-responsive, where the tumor regresses following treatment with a specific hormone (2) hormone-dependent, where removal of a hormonal stimulus causes tumor regression or (3) both. Hormone treatment of responsive tumors is usually only palliative, except in the case of the cytotoxic effect of glucocorticoids (for example, prednisone) on lymphomas. Removal of hormonal stimuli from hormone-dependent tumors can be accomplished by surgery, for example, in the case of orchiectomy for patients with advanced prostate cancer, or by drugs, for example in the case of breast cancer, treatment with the antiestrogen... 

Surgery can cure lung cancer, but only one in five patients are suitable for this treatment. If the tumor has not spread outside the chest and does not involve vital structures such as the liver, then surgical removal may be possible, but only if the patient does not also have severe bronchitis, heart disease, or other illnesses. Small cell lung cancer is treated with chemotherapy. Non-small cell cancer may be treated with radiotherapy and chemotherapy (as part of a research trial) or with supportive care. Radiotherapy is either radical or palliative. ... 

Surgical, local-interventional, regional and systemic procedures and palliative measures are available for the treatment of HCC. Longer survival periods can be achieved by surgery, which is considered to be the only form of potentially curative treatment for small tumours (< 3 cm, or even < 5 cm). 

Breast or Endometrial Carcinoma. Progesiins cun be used for palliative treatment of advanced carcinoma of the breast or endometrium. These agents should not be used in place of surgery, radiation, or chemotherapy. 

In 1993, Gaudy et ah described the same type of accident, in which 30 ml of 6.6% phenol solution (around 2 g) was injected for palliative splanchnic neurolysis in a patient with cancer of the pancreas. It seems obvious that, in spite of the fact that the injection was extravascular and given by a competent practitioner, there was massive vascular absorption, which can cause accidents that are fortunately reversible after treatment. It is most likely that the injections were made in edematous tissue that had been damaged by surgery beforehand and that this enhanced penetration. 

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