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

Skipworth, JRA; Damink, SWMO; Imber, C; Bridgewater, J; Pereira, SP; Malago, M; (2011) Review article: surgical, neo-adjuvant and adjuvant management strategies in biliary tract cancer. ALIMENT PHARM THER , 34 (9) 1063 - 1078. 10.1111/j.1365-2036.2011.04851.x. Gold open access

Abstract

BackgroundThe 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.AimTo review the current evidence base for surgical, adjuvant and neo-adjuvant techniques in the management of cholangiocarcinoma.MethodsA 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.ResultsData 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.ConclusionsThe 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.Aliment Pharmacol Ther 2011; 34: 1063-1078

Type:Article
Title:Review article: surgical, neo-adjuvant and adjuvant management strategies in biliary tract cancer
Open access status:An open access publication
DOI:10.1111/j.1365-2036.2011.04851.x
Publisher version:http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3235953/?tool=pubmed
Keywords:BILE-DUCT CANCER, PORTAL-VEIN EMBOLIZATION, SINGLE-CENTER EXPERIENCE, HILAR CHOLANGIOCARCINOMA, PHOTODYNAMIC THERAPY, INTRAHEPATIC CHOLANGIOCARCINOMA, LIVER-TRANSPLANTATION, POSTOPERATIVE RADIOTHERAPY, EXTENDED HEPATECTOMY, KLATSKIN-TUMORS
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Surgery and Interventional Science (Division of)

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