Palliative Surgery: When To and When Not To?

Surgeons, by nature, are often at the forefront of combating death and caring for the dying. While surgery and palliative care may seem mutually exclusive, surgeons have historically led the movement in palliative care as evidenced by landmark operations originally aimed to palliate suffering. Despite such foundations, awareness and application of palliative care by surgeons have been inconsistent. Given the inherent complexity in patient encounters that surgeons of all stages face daily, we propose a primer for bedside assistance and decisions for the busy surgeon caring for high-risk patients in need of palliative surgery. We will review the literature pertinent to palliative surgery—the past and future directions—and then present the Palliative Triangle and Best Case/Worst Case as models of communication. The goal is to assist practitioners “when to” and “when not to” perform palliative surgery, a decision-making process toward optimizing symptom control and quality of life.