04/12/2010 - Reflections of a Modern Dinosaur 03/29/2010 - I Don't Want to Put Him Through This 03/15/2010 - Who cares about the diagnosis? You’ve heard of palliative chemotherapy. Sure, there are cases where we hope for a cure or a remission (think lymphoma). But in many cases, chemo is offered to increase survival despite a grim prognosis. And you’ve heard of palliative radiotherapy. For example, four fractions could be given to a dog with osteosarcoma when amputation is not possible for the patient or not acceptable to the owner. Is there a treatment called palliative surgery? Is it doable? Is it ethical? Triple yes. There are many situations where palliative surgery can be offered. Here are a few recent cases. Sadie, a 10-year-old golden retriever presented with a hemoabdomen. Ultrasound or radiograph suggested a ruptured splenic mass, likely cancerous. If we offer to perform a splenectomy, then we are offering a form of palliative surgery. With hemangiosarcoma, the patient could die within three to six months. The owner elected splenectomy. Beaches, a 13-year-old mix breed dog, was diagnosed with recurrent malignant melanoma at the commissure of the lips. Besides the constant bleeding from self-trauma, she was otherwise doing very well. Because this tumor metastasizes quickly, preop thoracic rads were taken. Sure enough, the cancer had spread. The owner elected re-excision, for the sole purpose of improving short-term quality of life, including lack of oral bleeding. Geisha is a 9-year-old shepherd mix with anal sac carcinoma. Ultrasound revealed metastasis to the sublumbar lymph node and very possibly her spleen. The owner consented to removal of the anal sac tumor, debulking of the sublumbar lymph node and splenectomy. As of this writing, Geisha is receiving chemo and is feeling great, 11 months postop. There are many other similar situations: debulking a skin mass, removing anal sac tumors that have metastasized, amputating a painful leg even though there is evidence of metastatic disease… So yes, we do perform palliative surgery. In these three cases, an honest discussion with the owner led to a very clear understanding that we were not seeking a cure. We were only buying time. We were trying to “make the patient comfortable.” As long as the owner requests surgery, spontaneously or after an open discussion, then it is up to the practitioner to decide whether it is ethical or not. Do you find these stories shocking? Have you performed palliative surgery? Do you think it is unethical?
