Improvement of surgery, perioperative management, adjuvant therapy for biliary tract cancer patients

Abstract

Various aspects of improvement have been achieved in biliary tract cancer surgery. First, extended procedures have been aggressively indicated to increase resectability, and lower operative mortality resulting from refinement of perioperative patient management has elucidated survival benefit of extended resections. Thus, acceptable surgical and survival outcomes following combined hepatic artery resection have increased resectability in patients with advanced perihilar cholangiocarcinoma in a recent report. Second, several prospective studies are ongoing to validate the efficacy of adjuvant and neoadjuvant therapy, and selected patients with initially unresectable disease undergo resection after confirming favorable response to powerful chemotherapeutic regimens.

Third, minimum invasive surgeries (MIS) have been increasingly indicated and their acceptable surgical outcomes have shown the safety of the procedures. The oncological and survival benefit of such procedures need to be evaluated with large series data.