Palliative Surgery for Abdominal Malignancy: A Narrative Review With a Clinical Decision-Making Framework

Palliative surgery is often performed for various conditions in patients with incurable malignancies and limited life expectancy. However, it is associated with high morbidity and mortality rates, and its role and indications remain controversial, with no established guidelines.This narrative review aimed to examine recent studies on abdominal palliative surgery and explored reasons for its inconclusive evaluation. From a symptom-palliation perspective, we focused on how the term "palliative surgery" was applied, what outcomes were selected, and which methods were used to assess surgical outcomes in previous studies. We also identified issues in existing research and suggested improvements for future research.Inconsistent definition and the often confusing use of the term "palliative surgery" fuel the frequently debated role of surgery. In addition, variations in patient symptoms, surgical techniques, and selected surgical outcomes across studies complicate the assessment of its overall value. The lack of appropriate or consistent methods for examining outcomes, particularly symptom relief, restricts comparisons between surgical and nonsurgical treatments and prevents the proper evaluation of palliative surgery.Palliative surgery is an important treatment option for alleviating symptoms in end-of-life palliative care when appropriately selected. To validate issues and select appropriate treatment methods, discussions between the palliative care team are also inevitable.To address current challenges, we proposed a practical symptom-based framework that can guide the evaluation and selection of palliative interventions for common clinical scenarios in abdominal malignancies. Consistent with this approach, we presented a flowchart designed to facilitate more standardized and clinically applicable decision-making in palliative surgical care.