. Author manuscript; available in PMC: 2025 Dec 22.

Published before final editing as: Ann Surg. 2025 May 22:10.1097/SLA.0000000000006763. doi: 10.1097/SLA.0000000000006763

Table 2. Representative quotations acknowledging the uncertainty inherent in decision-making around non-curative surgery.

Surgeons both explicitly stated and implicitly suggested high levels of uncertainty in non-curative cancer care. Implicit indicators included waffling between risks and benefits or posing potential outcomes as questions.

Explicit Statements of Uncertainty	Implicit Statements of Uncertainty
“[W]e’re operating in this gray area right now in melanoma in particular, as we’re still learning how to deal with metastatic melanoma and what the appropriate treatment paradigms are.” (Participant #1) “But we don’t have the science behind it yet. If I knew that this person wasn’t curative and they were going to recur in two years and die within three years and I could have an upfront conversation with them...” (Participant #9) “This is a data-free zone. We don’t know if we’re actually going to limit your disease progression…It’s a gamble.” (Participant #18) “[W]hen I propose to do surgery for patients of any kind with cancer, I never tell them, ‘Well, I’m going to cure you’ because chances are I’m not. And chances are, even if I think I am, I don’t know because it can still recur.” (Participant #11)	“Recognizing that surgery is not going to - almost certainly not going to [pauses], well, it depends. But I’m not operating for curative intent or necessarily even for longevity or length of life, but it would be for quality of life…Now, that said…there’s certainly a distinct possibility that they have complications…which could make them feel worse…” (Participant #1) “[C]an I help you live longer relative to the disease? Can I help you with symptoms that you might develop if it’s allowed to progress in that location?” (Participant #13) “I think we would tell the patient, ‘Look, I think this is curative intent. Let’s go in and take that last thing out. I can’t guarantee you that nothing will ever come back.’ With two lesions, it starts to become that borderline. Like are we offering curative resection? Are we offering reduction of morbidity?” (Participant #5)

Explicit Statements of Uncertainty

Implicit Statements of Uncertainty

“[W]e’re operating in this gray area right now in melanoma in particular, as we’re still learning how to deal with metastatic melanoma and what the appropriate treatment paradigms are.” (Participant #1)

“But we don’t have the science behind it yet. If I knew that this person wasn’t curative and they were going to recur in two years and die within three years and I could have an upfront conversation with them...” (Participant #9)

“This is a data-free zone. We don’t know if we’re actually going to limit your disease progression…It’s a gamble.” (Participant #18)

“[W]hen I propose to do surgery for patients of any kind with cancer, I never tell them, ‘Well, I’m going to cure you’ because chances are I’m not. And chances are, even if I think I am, I don’t know because it can still recur.” (Participant #11)

“Recognizing that surgery is not going to - almost certainly not going to [pauses], well, it depends. But I’m not operating for curative intent or necessarily even for longevity or length of life, but it would be for quality of life…Now, that said…there’s certainly a distinct possibility that they have complications…which could make them feel worse…” (Participant #1)

“[C]an I help you live longer relative to the disease? Can I help you with symptoms that you might develop if it’s allowed to progress in that location?” (Participant #13)

“I think we would tell the patient, ‘Look, I think this is curative intent. Let’s go in and take that last thing out. I can’t guarantee you that nothing will ever come back.’ With two lesions, it starts to become that borderline. Like are we offering curative resection? Are we offering reduction of morbidity?” (Participant #5)