Predicting Life Expectancy and Symptom Relief Following Surgery for Advanced Malignancy

We prospectively evaluated surgeons’ ability to predict outcomes of life expectancy and symptom relief following major surgery for patients with advanced malignancies.

Fifty-seven patients with advanced malignancies were evaluated regarding major symptoms requiring a surgical intervention and followed until death or last contact. The patients’ surgeons answered questions preoperatively and postoperatively, relating to issues such as estimated survival time and likelihood of symptom relief following surgery. We compared these estimates with patients’ clinical outcomes and responses to a symptom questionnaire completed just prior to surgery, and 2 weeks, 6 weeks, and 3 months following surgery.

Surgeons’ preoperative estimates of patient survival agreed with survival outcomes. Preoperatively, surgeons accurately identified cases where a patient was expected to live less than 1 year without surgery (P < 0.0001) and with surgery (P = 0.0342). Surgeons’ preoperative estimates of the success of symptom improvement following surgery did not correlate in general with patients’ self-assessments (P = 0.6454). Specifically, surgeons underestimated their success in symptom resolution. However, there were statistically significant differences between patients who were judged by surgeons postoperatively to have mild or no palliation compared with those with excellent (P = 0.0372) and good (P = 0.0203) palliation.

Preoperatively, surgeons accurately estimated patients’ survival time with surgery. Surgeons’ postoperative estimates of success of symptom relief agreed with patients’ self-assessments. Preoperatively, surgeons tended to underestimate their patients’ symptom relief. Surgeons may wish to consider other criteria than their predictions for symptom relief in deciding whether a patient is a candidate for palliative surgery.