• Roderich E Schwarz.
• Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Division of Surgical Oncology, The Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA. r.schwarz@umdnj.edu
• World J Surg Oncol. 2007 Jan 1;5:32.

BackgroundPostoperative assessment of indications for cancer directed surgical procedures frequently differs from preoperative plans.MethodsSpecifically defined preoperative indications and postoperative results were followed prospectively over 48 months in a single surgeon academic practice, and relationships to postoperative outcomes evaluated.ResultsOperations were performed on 406 patients with a median age of 61 (range: 18-90). Major operations (n = 303, 75%) involved 270 abdominal resections including pancreatectomies (37%), liver resections (23%), gastrectomies (19%), and others (21%). Preoperative curative (70%), diagnostic (38%), palliative (12%), access (9%), and non-cancer related therapy (21%) goals were in part combined in 176 patients (43%). Postoperative assessment differed from preoperative goals in 118 patients (29%). Predominant reasons were proof of benign disease (n = 35), incomplete resection (R1 or R2, n = 23), unresectability by laparoscopy (n = 21) or laparotomy (n = 21), or others (n = 18). Potential preoperative cure or palliation goals were not achieved in 37% or 15% of cases, respectively. Circumstances of changed treatment intent were specific for disease site.ConclusionPreoperative therapeutic intent frequently differs from postoperative assessments in gastrointestinal cancer, based on shortcomings in diagnosis or therapy. Formulations of precise operative indications are recommended to optimize individual outcomes and avoid unnecessary or ineffective procedures.

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