Surgical futility in hepatopancreatobiliary (HPB) oncology is often defined by clinical outcomes — mortality, major morbidity, or early recurrence — yet these metrics overlook the patient’s lived experience and goals. This commentary argues that futility must be reframed from a purely technical judgement to a relational construct integrating patient-defined values. We review recent multicentre studies which refine predictive models across HPB malignancies, but remain rooted in clinician-centric paradigms. We propose a holistic framework that (i) documents goal-concordant decisions through structured shared decision-making; (ii) embeds patient-reported outcome measures alongside clinical endpoints; and (iii) uses predictive models as decision aids rather than arbiters. By coupling quantitative estimates with qualitative patient goals, futility is transformed into an ethically grounded, patient-centred endpoint that aligns surgical intent with what truly matters to the patient.