Management of patients with incurable cancer is complex and requires multidisciplinary input. The surgeon can play a central role. We present two cases from 2016-7, in which we highlight the role of surgery in ameliorating symptoms, thus improving the quality of life in oncology patients.
Patient one (male, 16 years) was diagnosed with peritoneal mesothelioma in 2016 following presentation with abdominal pain and ascites. He received chemotherapy, but subsequently refused any further systemic treatment. His ascites progressed and became symptomatic. An indwelling abdominal drain was inserted and with regular drainage has reduced respiratory compromise and pain. On recent review, he was alive 18 months after diagnosis, unusual when compared to the adult literature where survival is typically 6-12 months without treatment. The drain has been key to his comfort in this extended palliative period.
Patient two (male, 5 years) was diagnosed with metastatic malignant rhabdoid tumour in 2017 after 6 months of increasing abdominal pain, constipation and urinary difficulties. Imaging revealed a large pelvic mass with widespread intra-abdominal lymph node and pulmonary metastases. The tumour was refractory to multi-agent chemotherapy. Tumour progression caused bladder obstruction, requiring bilateral nephrostomies, and colonic obstruction, requiring loop colostomy. These multiple surgical interventions allowed him to be cared for both at home and in a hospice. The loop colostomy allowed him to live long enough to see the birth of his sibling.
CONCLUSIONS: Published literature describing the paediatric surgeon’s role in palliative care is limited. Surgeons can play a pivotal role in ensuring children receive high quality care at the end of their lives. Management should be individualised and take patient- and family-specific factors into account. Decision making can be complex and requires appropriate multidisciplinary input in counselling patients regarding their options, risk and benefit profiles.