Current Status and Future Perspectives of Perioperative Therapy for Resectable Biliary Tract Cancer: A Multidisciplinary Review

Abstract

Biliary tract cancers (BTCs) are a group of aggressive malignancies that arise from the bile duct and gallbladder. BTCs include intrahepatic cholangiocarcinoma (IH-CCA), extrahepatic cholangiocarcinoma (EH-CCA), and gallbladder cancer (GBCA). BTCs are highly heterogeneous cancers in terms of anatomical, clinical, and pathological characteristics. Until recently, the treatment of resectable BTC, including surgery, adjuvant chemotherapy, and radiation therapy, has largely been based on institutional practice guidelines and evidence from small retrospective studies. Recently, several large randomized prospective trials have been published, and there are ongoing randomized trials for resectable BTC. In this article, we review prior and recently updated evidence regarding surgery, adjuvant and neoadjuvant chemotherapy, and adjuvant radiation therapy for patients with resectable BTC.

Keywords: adjuvant chemotherapy; biliary tract cancer; cholangiocarcinoma; gallbladder cancer; radiation therapy; surgery.

Figure 1

Structural classification of biliary tract cancer, IHCC = intrahepatic cholangiocarcinoma, CCA = cholangiocarcinoma, and GBCA = gallbladder cancer.

Figure 2

Bismuth–Corlette classification of perihilar cholangiocarcinoma, Type I, confined to the common hepatic duct; Type II, involved the confluence of the common hepatic duct; Type IIIa, involved the confluence and extended to the bifurcation of right hepatic duct; Type IIIb, involved the confluence and extended to the bifurcation of the left hepatic duct; and Type IV, involved the confluence and extended to the bifurcation of both right and left hepatic ducts.