ABSTRACT
The surgery of intra-abdominal malignancy forms a large proportion of the workload of a gastrointestinal surgeon. Almost without exception, the only single intervention that can offer a patient the chance of a cure is a well-performed operative resection, with the addition of neoadjuvant (preoperative) radiotherapy and/or chemotherapy in selected cases. However, the need for a laparotomy to establish whether potentially curative surgery is possible has diminished with improvements in preoperative imaging, and palliative intervention is now shared with radiologists, radiotherapists and oncologists. When a curative resection is possible, it is of the utmost importance that a surgeon does not jeopardise the possibility of cure by inadequate or poorly planned surgery. When cure is no longer possible, radical surgery sometimes still offers the best palliation, but the surgeon must avoid inappropriate radical surgery. A simpler operative procedure may be as effective in relieving symptoms, and in other situations surgery may have no place. Surgeons must understand the methods of spread, and the natural history of, the various intra-abdominal malignancies if they are to make the best operative decisions.
