Introduction

Surgical oncology is a diverse and challenging subspecialty. Despite the obvious intricacies of surgery in complex oncologic cases, the role of palliative surgery is perhaps one of the most complex aspects of surgical oncology. The decision to perform palliative surgery requires an understanding of the potential morbidities and mortalities associated with surgical procedures. This must be balanced against the natural history of the underlying malignancy along with possible benefits, such as the patient's quality of life and potential life expectancy. Most often there is not a single correct approach when evaluating palliative surgical options. A treatment approach can only be determined through evaluation of all potential risks and benefits in conjunction with extensive discussion with the patient and family.

The decision to perform a palliative operation is usually based on a number of factors including the life expectancy of the patient, the quality of the patient's life, the expected benefit of the operation, and the availability of less invasive palliative approaches. In general, performing a palliative operation will not extend the life expectancy of the patient. Although this may be intuitively obvious, it is often difficult for patients and families to understand and accept this hypothesis. Before commencing with a palliative operation, it is important that both the patient and their family understand this concept. This fact has to be established before the issue of attempting to improve quality of life can be addressed.