This uncommissioned review article was subject to full peer-review.
Review article: surgical, neo-adjuvant and adjuvant management strategies in biliary tract cancer
Article first published online: 20 SEP 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 34, Issue 9, pages 1063–1078, November 2011
How to Cite
Skipworth, J. R. A., Olde Damink, S. W. M., Imber, C., Bridgewater, J., Pereira, S. P. and Malagó, M. (2011), Review article: surgical, neo-adjuvant and adjuvant management strategies in biliary tract cancer. Alimentary Pharmacology & Therapeutics, 34: 1063–1078. doi: 10.1111/j.1365-2036.2011.04851.x
- Issue published online: 10 OCT 2011
- Article first published online: 20 SEP 2011
- Publication data Submitted 25 August 2010 First decision 21 September 2010 Resubmitted 22 August 2011 Accepted 23 August 2011 EV Pub Online 20 September 2011
Aliment Pharmacol Ther 2011; 34: 1063–1078
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.