Palliative Reconstructive Surgery: Contextualizing Palliation in Resource-Poor Settings

Abstract

Introduction. Palliative care in Kenya and the larger Sub-Saharan Africa is considered a preserve of hospices, where these exist. Surgical training does not arm the surgeon with the skills needed to deal with the care of palliative patients. Resource constraints demand that the surgeon be multidiscipline trained so as to be able to adequately address the needs of a growing population of patients that could benefit from surgical palliation. Patients and Methods. The author describes his experience in the management of a series of 31 palliative care patients, aged 8 to 82 years. There were a total of nine known or presumed mortalities in the first year following surgery; 17 patients experienced an improved quality of life for at least 6 months after surgery. Fourteen of these were disease-free at 6 months. Conclusion. Palliative reconstructive surgery is indicated in a select number of patients. Although cure is not the primary intent of palliative surgery, the potential benefits of an improved quality of life and the possibility of cure should encourage a more proactive role for the surgeon. The need for palliative care can be expected to increase significantly in Africa, with the estimated fourfold increase of cancer patients over the next 50 years.

Palliative surgery in gastrointestinal malignancy: experience from a regional cancer centre

“…Thus, surgery and anaesthesia are components of palliative care in any setting. 3 Palliative GI surgery is common in surgical oncology practice, consisting of 20-30% of all surgery performed inwestern world according to various literature. 2,6 In our setup with lack of proper screening and health being the most neglected part of life, with the presentation usually in stage III/ IV as compared to early presentation, the role of palliation becomes even more important.…”

“…In such areas, the surgical workforce might feel obligated to triage the patients because it might get too late to help the curable patients. 3 But To relieve suffering in people is the ultimate goal of all medical and surgical specialties and patients with terminal illnesses can be helped to live and die without physical or psychosocial pain, financial difficulties, or stigma. 3 This issue is to be solved but the goal of palliative surgery is not to perform palliative surgery, i.e.…”

“…1,2 Surgery is an important palliative method for patients with advanced malignant disease, There is currently no consensus on the definition of palliative surgery authors differ suggesting definitions based on preoperative criteria, postoperative criteria, and even patient prognosis. 1,3 Palliative surgery is generally refers to surgery performed with the intent of improving quality of life or relieving symptoms caused by advanced disease Palliative surgery is frequently confused with or used interchangeably with non-curative surgery. 4 In fact, the key difference between palliative and non-curative surgery lies in the intent of surgery, namely the intent to provide asymptomatic patients with an oncologic cure in non-curative surgery versus the intent to relieve symptoms without consideration of oncologic benefit in palliative surgery.…”

Fardeau des maladies chroniques en Afrique subsaharienne : plaidoyer pour une mise en place des soins palliatifs et d’accompagnement en fin de vie en République démocratique du Congo

“…Cela améliora la qualité de vie des malades chroniques en fin de vie et des familles par un soutien médical contextualisé [14,15]. Les soins palliatifs sont des soins médicaux qui améliorent la qualité de vie physique, sociale, psychologique et spirituelle du patient et de sa famille et vont au-delà de soulager la douleur.…”

The Case for Palliative Reconstruction

“…This is due to significant risks associated with complex reconstruction in general, including physiologic risks and economic implications. 4 Further, it remains unknown whether palliative reconstruction actually translates to improved quality of life. An additional factor potentially responsible for its restricted application relates to reduced surgeon comfort/experience with reconstruction in terminal patients.…”