The Role of Surgery for Loco-regional and Advanced Urological Cancers

Kit Mun Chow; Kae Jack Tay; John Yuen; Kenneth Chen

Disclosures

Curr Opin Urol. 2022;32(6):634-642. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: There is a general misconception that surgery is the antithesis of palliation. However, symptom mitigation, the basic tenet of palliative interventions, can be achieved by invasive procedures. Surgical care, thus, plays an important role in palliative oncology, alongside radiation and systemic therapy. There is global movement to improve palliation in oncology, and thus it is timely to evaluate the role of surgical interventions can play in this setting.

Recent Findings: Many of the surgical interventions done with palliative intent were first established as curative options. Most studies looked at interventions for local control of primary tumour including extirpative surgeries, while some studies studied pain relief for bone metastases. Results show that patients have an acceptable survival outcome and complication rate comparable to those done in the curative setting. However, not all studies report functional outcomes and symptom-relief consistently, highlighting an unmet need.

Summary: More studies are needed to further define the role of surgery in palliative care. Randomized controlled trials studying surgical intervention in the palliative setting will be challenging because of lack of equipoise, inherent bias in patient and disease characteristics in those who undergo surgery. Nonetheless, studies should endeavour to study symptom-free survival and PROMs as meaningful endpoints of interventions performed in a palliative setting rather than solely focus on hard oncological endpoints of survival.

Introduction

The Center to Advance Palliative Care defines palliative care as specialized medical care for people living with a serious illness, focused on relieving the symptoms and stress of that illness.[1] There is a general misconception amongst physicians that palliation is pharmacocentric and surgery is the antithesis,[2–4] causing high morbidity and mortality without conferring significant benefits. However, symptom mitigation, which is the basic tenet of palliative intervention, can also be achieved by invasive procedures. Surgical care, thus, plays an important role in palliative oncology, alongside radiation therapy and systemic therapy.

The concept of surgical palliation in advanced genitourinary malignancy has emboldened in the last few decades owing to advances in imaging, perioperative care and surgical techniques. Increasingly, functional outcomes are also being studied as significant endpoints in late-stage disease. This chapter aims to summarize the growing body of literature over the past 2 years, highlighting key advances, new evidence and current perspectives on the role of palliative surgery for genitourinary cancers.

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