ABSTRACT
Background: 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. Materials and Methods: Fifteen patients referred with advanced malignant disease involving a limb girdle
were reviewed. Results: 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. Conclusion: 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.
KEY WORDS
Futility - palliation - quality of life - surgery
