[Palliative Surgical Approaches for Malignant Upper Gastrointestinal Obstruction]

Malignant obstruction caused by advanced upper gastrointestinal (GI) cancers significantly impairs patients' quality of life (QOL), often leading to dysphagia, vomiting, and nutritional deterioration. While endoscopic and pharmacologic therapies serve as primary palliative approaches, surgical intervention remains a valuable option, particularly when endoscopic treatments are infeasible or ineffective. This article reviews the current role of palliative surgical treatments for malignant GI obstruction, focusing on esophageal bypass for esophageal cancer, and gastrojejunostomy or palliative gastrectomy for advanced gastric cancer. Esophageal bypass, though less commonly performed today due to the availability of self-expandable metallic stents, remains suitable for selected patients with a good performance status and expected survival exceeding 3 months. For gastric outlet obstruction, laparoscopic gastrojejunostomy is frequently employed and offers rapid relief of symptoms with early resumption of oral intake. Palliative gastrectomy may be indicated in younger patients with better performance status and significant tumor-related symptoms, although it is more invasive. The choice of surgical procedure should be guided by patients' clinical condition, prognosis, and treatment goals. Recent literature shows no consensus on the superior approach, emphasizing the importance of individualized treatment planning, careful perioperative management, and timely integration with systemic therapy to optimize outcomes in palliative settings.