Research Article

Palliative Reconstructive Surgery: Contextualizing Palliation in Resource-Poor Settings

Table 1

Demographics of patients undergoing palliative reconstructive surgery.

SexAgeMain complaintsComorbidityAnatomical siteHistological diagnosisPrevious intervention(s)LOSOutcome*Quality of life*Medical oncology referrals and post-op statusRecurrence**Status at 6 months

1M20Pain, smellNoneBackFibrosarcoma3 resections3 weeksGoodExcellentRefused referralAlive

2F50Pain, smellNoneBreast, left armMalignant phyllodes2 resections/radiotherapy2 monthsGoodFairRefused referralAlive

3M40Pain, smellAIDS on HAARTPeno-scroto-perinealGiant condyloma acuminatumNone2 monthsGoodExcellentNot referredAlive

4M30Pain, smellNonePerineal/pelvicPoorly differentiated sarcomaNone3 weeksGoodGoodChemotherapy delayedAlive

5M20Deformity, difficulty eating/drinkingNoneMandible/maxillaWell differentiated jaw osteosarcomasBiopsy, palliative care6 weeksExcellentGoodRefused referralAlive

6F25Pain, smellNoneBreastPoorly differentiated adenocarcinomaNone1 monthGoodGoodReferred, lost to follow-up?Presumed dead

7M45Pain, oral incontinenceNoneCheekSquamous cell carcinoma of oral cavityDebridement2 monthsPoorPoorDied in hospital awaiting oncology visitDead

8F19Pain, unable to ambulatePathological fractures femur, humerusArms (bilateral)NF1 with metastatic MPNSTORIF humerus, femur+1 monthFairPoorReferred, lost to follow-up?Presumed dead

9F20Pain, bowel obstructionNoneRetroperitoneumNF1 with retroperitoneal MPNSTNone1 monthGoodGoodReferred, lost to follow-up?Presumed dead

10M40Pain, early satietyNoneRetroperitoneumNF1 with retroperitoneal MPNSTPlexiform neurofibroma excised2 weeksGoodFairReferred, lost to follow-up?Presumed dead

11M40Pain, deformityNoneMaxillaAmeloblastic carcinomaNone3 weeksGoodExcellentChemotherapyAlive

12M35Smell, oral incontinenceNoneMandible/oral cavityAmeloblastoma with SCC in fistulaNone3 weeksExcellentGoodAwaits mandibular reconstructionAlive

13M45Pain, smellNoneAbdominal wallFibrosarcomaMultiple4 weeksExcellentGoodReferred, lost to follow-upUnknown

14F32Pain, soiling of clothesNoneNeckNodal SCC with no primaryResection and radiotherapy3 weeksExcellentExcellentReferred, lost to follow-upUnknown

15F22Pain, odynophagiaNoneNeckHigh grade glomus jugulare tumor1 resection2 weeksGoodExcellentNot referredAlive

16M55Pain, smellNoneScalp/skullSebaceous carcinomaNone3 weeksGoodExcellentCould not afford chemoradiotherapyAlive

17M20Shortness of breath, tiredness? Cor pulmonaleExtremities, trunk, intrathoracicPlexiform neurofibromasNone2 weeksPoorPoorPerioperative mortalityDead

18M8Pain, smellMalnutritionLeft eyeRetinoblastomaNone2 weeksGoodFairChemotherapy, lost to follow-up?Unknown

19F40Smell, painNoneShoulderFibrosarcomaNone3 weeksExcellentExcellentChemotherapyAlive

20M35Smell, pain, deformityNoneMaxillaAmeloblastic carcinomaNone3 weeksExcellentExcellentChemotherapyAlive

21F24Pain, smell, deformityNoneMaxillaAmeloblastic carcinomaDebulking of odontogenic keratocyst+4 weeksGoodFairCould not afford chemoradiotherapyAlive

22F16Pain, inability to walkGroin nodal metastasesPopliteal fossaMarjolin’s ulcer (SCC)Incision and drainage, groin “abscess”3 weeksGoodExcellentChemotherapyAlive

23M25Pain, smellNoneBackFibrosarcomaAttempted resection3 weeksExcellentExcellentReferred, lost to follow-upUnknown

24F35Pain, smell, oral incontinenceAIDS on HAARTLower lipSquamous cell carcinomaNone3 weeksGoodGoodLost to follow-up after discharge?Unknown

25M40Pain, inability to walkNoneRight thighHigh grade fibrosarcomaNone4 weeksGoodFairPerioperative mortalityDead

26F20Smell, soiling of clothesDebridement and STSGRight elbowMarjolin’s ulcer (SCC)None2 weeksFairGoodRadiotherapyAlive

27M82Smell, pain, difficulty opening mouthChronic smokerMandible, floor of mouthSquamous cell carcinomaNone3 weeksGoodGoodUnder follow upAlive

28F56Smell, pain, difficulty opening mouthHIV on HAARTLower lip, floor of mouthSquamous cell carcinomaNone6 weeksGoodGoodRadiotherapyAlive

29F25Pain, smell, difficulty opening mouthNoneNeck, cheek, floor of mouthSquamous cell carcinomaNone3 weeksExcellentExcellentRadiotherapyAlive

30F22Pain, smell, difficulty moving aroundNoneNeck, floor of mouthLiposarcoma3 resections2 weeksExcellentExcellentReferred for chemotherapyAlive

31M35Pain, inability to walkNoneRight thighFibrosarcomaNone2 weeksGoodGoodReferred for chemotherapyAlive

SCC: squamous cell carcinoma; AIDS: acquired immune deficiency syndrome; HAART: highly active antiretroviral treatment; MPNST: malignant peripheral nerve sheath tumor; ORIF: open reduction and internal fixation; LOS: length of hospital stay.
All previous surgical interventions were performed in other institutions except two+.
*Immediate outcome/quality of life. Poor: quality of life unchanged; patient functioning at or below preoperative status. Fair: symptoms improved, but patient still complains of pain, or other disability, or no odor but needs to continue with wound dressing changes after surgery. Good: most symptoms gone, and patient independently performs all activities of life but is unable to carry out demanding/manual tasks. Excellent: patient is back to premorbid activities, with no physical restrictions.
**Status of patient at 6 months following surgery.
Recurrence at last review: ✓: clinical evidence of recurrence; : no evidence of recurrence; ?: status unknown.