[Surgical intervention in palliative care]

In palliative care, surgical intervention is contra-indicated if there is intra-abdominal carcinomatosis as evidenced by diffuse intra-abdominal tumors, and massive ascites which re -accumulates rapidly after paracentesis. Surgical intervention should be considered, if the following criteria are fulfilled even in palliative care. (1) The patient' s general condition is good, i.e. does not have widely disseminated disease and has been independent and active. (2) Previous laparotomy findings do not preclude the prospect of successful intervention. (3) An easily reversible cause seems likely, e.g. postoperative adhesions or a single discrete neoplastic obstruction. (4) The patient is willing to undergo surgery. In patients in whom an operative approach is contra-indicated, it is generally possible to relieve symptoms adequately with drugs, a nasogastric tube and i.v. fluids are rarely necessary.