Multivisceral Resections in GI Oncology: Where to Draw the Line?

Background: Multivisceral resection (MVR) in gastrointestinal (GI) oncology represents one of the most formidable undertakings in surgical practice, demanding meticulous technical execution, multidisciplinary coordination and the courage to operate at the very limits of oncologic feasibility. Objective: This review synthesises the latest evidence (2000–2025) on the indications, contraindications, technical nuances, outcomes and ethical considerations of MVR, with a focus on defining the decision-making boundaries that separate justified surgical aggression from undue risk. Methods: A comprehensive search of PubMed and Embase was conducted, emphasising systematic reviews, meta-analyses, randomised controlled trials and large multicentre cohort studies relevant to MVR in GI cancers. Evidence was evaluated for technical approaches, survival outcomes, perioperative morbidity and ethical dimensions. Results: Contemporary literature supports the selective use of MVR in locally advanced gastric, colorectal and pancreatic cancers, achieving acceptable morbidity and mortality in high-volume centres when R0 resection is feasible. Advances in minimally invasive techniques, perioperative optimisation and enhanced recovery protocols have improved outcomes; however, complications remain significant. Patient selection, accurate preoperative staging and multidisciplinary tumour board input are paramount to success. Conclusion: MVR remains a powerful but high-risk tool in the surgical oncologist’s armamentarium. This review provides a framework for surgeons to identify the threshold between justified aggression and undue risk in MVR for GI malignancies.