| Abstrakt: |
Since World War II, major advances in surgical management and life support have made possible operative procedures that could not have been undertaken previously. As a result of these encouraging developments, it has become apparent that the possibilities for palliative surgery now demand our attention and should be considered along with radiotherapy, chemotherapy, cryosurgery, and immunotherapy as suitable management of the patient with advanced malignancy. It should be possible, on the basis of all available information, to excise the primary lesion and all metastases without leaving known tumor. This concept differs from that of 'curability' in that it includes lesions which can be removed, but which are statistically not likely to be cured. The surgeon must be reasonably certain that the patient can be reconstructed sufficiently well and that his quality of survival will be superior to the disabilities that would be expected if the local tumor were left uncontrolled. The patient being considered for massive palliative surgery must, of course, be a sufficiently good surgical risk to tolerate the planned procedures. This criterion is not intended to be taken in the medicolegal sense, but rather implies that the patient and his family must fully understand the massive nature of the surgery planned. More important, all concerned must have a realistic expectation as to what can be accomplished. In applying these criteria to carefully selected cases, we have been encouraged to find that most patients are willing to undertake procedures that offer virtually no chance for cure in an effort to obtain the best possible quality of survival for as long as useful life can be prolonged. Morbidity as a result of these palliative attempts has been acceptably low and patient acceptance of these concepts very high. [ABSTRACT FROM AUTHOR] |
Plný text