Review article: surgical, neo-adjuvant and adjuvant management strategies in biliary tract cancer

Authors

  • J. R. A. Skipworth,

    1. Department of Surgery and Interventional Science, University College London, London, UK.
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  • S. W. M. Olde Damink,

    1. Department of Surgery and Interventional Science, University College London, London, UK.
    2. Department of Hepatopancreaticobiliary Surgery, Royal Free Hospital NHS Trust, London, UK.
    3. Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
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  • C. Imber,

    1. Department of Hepatopancreaticobiliary Surgery, Royal Free Hospital NHS Trust, London, UK.
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  • J. Bridgewater,

    1. University College London Cancer Institute, London, UK.
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  • S. P. Pereira,

    1. Department of Gastroenterology, University College London Hospital NHS Foundation Trust, London, and Institute of Hepatology, University College London Medical School, London, UK.
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  • M. Malagó

    1. Department of Surgery and Interventional Science, University College London, London, UK.
    2. Department of Hepatopancreaticobiliary Surgery, Royal Free Hospital NHS Trust, London, UK.
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  • This uncommissioned review article was subject to full peer-review.

Dr J. R. A. Skipworth, Department of Surgery & Interventional Science, 4th Floor, Medical School Building, 74 Huntley Street, University College London, London, WC1E 6AU, UK.
E-mail: j.skipworth@ucl.ac.uk

Abstract

Aliment Pharmacol Ther 2011; 34: 1063–1078

Summary

Background  The majority of patients with cholangiocarcinoma present with advanced, irresectable tumours associated with poor prognosis. The incidence and mortality rates associated with cholangiocarcinoma continue to rise, mandating the development of novel strategies for early detection, improved resection and treatment of residual lesions.

Aim  To review the current evidence base for surgical, adjuvant and neo-adjuvant techniques in the management of cholangiocarcinoma.

Methods  A search strategy incorporating PubMed/Medline search engines and utilising the key words biliary tract carcinoma; cholangiocarcinoma; management; surgery; chemotherapy; radiotherapy; photodynamic therapy; and radiofrequency ablation, in various combinations, was employed.

Results  Data on neo-adjuvant and adjuvant techniques remain limited, and much of the literature concerns palliation of inoperable disease. The only opportunity for long-term survival remains surgical resection with negative pathological margins or liver transplantation, both of which remain possible in only a minority of selected patients. Neo-adjuvant and adjuvant techniques currently provide only limited success in improving survival.

Conclusions  The development of novel strategies and treatment techniques is crucial. However, the shortage of randomised controlled trials is compounded by the low feasibility of conducting adequately powered trials in liver surgery, due to the large sample sizes that are required.

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