Disparities in surgical palliation for malignant gastrointestinal obstruction: a review

Surgical palliation is a critical component of comprehensive care for patients with advanced, unresectable cancer, often measured by symptom relief and improved quality of life (QOL). Malignant gastrointestinal (GI) obstructions-gastric outlet obstruction (GOO), malignant bowel obstruction (MBO), and biliary obstruction-are some of the most common indications for palliative surgery and associated with life-limiting nausea, vomiting, per oral (PO) intolerance, or jaundice. Treatment is inherently multimodal, including percutaneous, endoscopic, and operative approaches, with selection determined by disease burden, patient condition, and prognosis. Despite such advances in modalities, disparities in access to and outcomes of palliative surgical care are poorly characterized. Current evidence suggests racial and ethnic minorities, lower socioeconomic status, and rural settings are associated with reduced access to palliative care, delayed presentations, and poor outcomes. However, data specific to palliative surgery, including malignant GI obstructions, are limited, as most studies prioritize comparing efficacy of treatment modalities as opposed to disparities in palliative surgical care. This review surveys current surgical palliative options for GOO, MBO, and biliary obstruction and examines available evidence on disparities in access, utilization, and outcomes. We also highlight gaps in palliative surgical research that may hamper high-quality disparities research and propose future directions focused on standardized definitions, patient-centered palliative outcomes, and improved methodologies to better identify and address disparities in palliative surgical care.