Overview of Emerging Strategies in the Surgical Management of Biliary Tract Tumors

Abstract

Cholangiocarcinoma can arise anywhere along the biliary system. Patients with biliary tract cancer (intrahepatic, peri-hilar, extra-hepatic, and gallbladder cancer) tend to have advanced disease at presentation, with a median survival of about 6-9 months from the time of diagnosis {[}1]. Surgery with clear histologic margins (R0 resection) in combination with appropriate lymph node dissection is the only chance of cure with published five-year survival rates of 24-40 \% {[}2]. Curative surgical resection, however, is only feasible in a minority of patients {[}3], even in the setting of radical hepatic surgery {[}4, 5]. The management of patients with biliary tract cancer is complex and has been changing with the development of novel treatment alternatives. Furthermore, more aggressive surgical approaches have emerged over the past decade to treat patients previously considered to have unresectable disease, including portal vein embolization, combined hepatectomy with vascular resection, non-touch technique and, in highly selected patients, liver transplantation {[}6]. Minimal invasive surgery in hepato-pancreato-biliary diseases and neoadjuvant treatment is also among the last newly strategies added to the biliary tract cancer therapy. Indications, surgical selection, possible benefits, and limitations of each of these treatment alternatives will be discussed in the light of the most recent literature.