Palliative and Supportive Surgery for Gastrointestinal Cancer

Abstract

Gastrointestinal cancer is a common medical problem in Western countries. One-third of the 16 000 annual cancer deaths in Switzerland are attributed to gastrointestinal cancer [1]. This means that 1 in 12 inhabitants of this country will eventually die of such a tumor. Due to the limited efficacy of alternative treatment modalities (radiotherapy, chemotherapy), surgery plays the major role in the treatment of gastrointestinal tract cancer. Early stage tumors can usually be cured by surgical resection. However, in population-based studies, these prognostically favorable cases are extremely rare. Only 93 UICC stage I cases (0.7%) were registered at the Birmingham Cancer Registry among 13 175 patients with gastric carcinoma from the West Midland area during the period 1960–1969 [2]. Eighty percent of the population in this study had metastatic UICC stage IV disease far beyond any chance of cure. Similar low resectability rates are being found in esophageal cancer, hepatobiliary carcinoma, and pancreatic cancer. Fortunately, in the most common gastrointestinal malignancy, colorectal carcinoma, resectability is much higher, 70%–75%, and half of these patients will be cured by radical resection [3]. Considering the long-term results for all other gastrointestinal carcinomas, even so-called curative resections must in fact be considered palliative procedures. What are the role and potential of surgery for palliation in gastrointestinal cancer?