Palliative surgical care focuses on symptom relief and control, often in chronic conditions or in locally advanced or metastatic cancer where cure is not possible. Surgery can be considered for palliation to provide symptom control and improve quality of life. Understanding patients’ goals of care are essential when considering palliative surgery to ensure these goals can be accomplished in a meaningful way while minimizing harm and suffering. A multidisciplinary team is essential to understand disease prognosis, alternative options for symptom-control, and continuity of care. Mortality and morbidity of palliative surgery are high, so experience in patient selection and management options is exceedingly important to provide benefit to patients. Symptoms can be secondary to cancer intrinsic to the gastrointestinal tract or extrinsic to it through external compression or peritoneal carcinomatosis. Common presentations where surgical palliation can be considered include obstruction, perforation, bleeding, and pain.