Past, Present, and Future Management of Localized Biliary Tract Malignancies

Surg Oncol Clin N Am. 2023 Jan;32(1):83-99. doi: 10.1016/j.soc.2022.07.007. Epub 2022 Nov 3.

Abstract

Most of the patients with gallbladder cancer (GBC), intrahepatic cholangiocarcinoma (iCCA), and peri-hilar cholangiocarcinoma (pCCA) present with advanced disease. Complete staging with multiphasic liver imaging is essential to determine the extent of disease. Operative goals should include a margin-negative resection, portal lymphadenectomy for staging, and sufficient remnant liver volume. Biliary tract malignancies have distinct mutational drivers (GBC and pCCA = ERBB2 in 20%; iCCA = fibroblast growth factor receptor 2 or isocitrate dehydrogenase 1 in 20%) amenable to therapy with inhibitors. Clinical trials assessing neoadjuvant, peri-operative, and adjuvant treatments continue to evolve and now include targeted inhibitors and the integration of hepatic arterial infusion.

Keywords: Biliary tract cancer; Cholangiocarcinoma; Clinical trials; Gallbladder cancer; Liver resection.

Publication types

  • Review

MeSH terms

  • Bile Duct Neoplasms* / pathology
  • Bile Ducts, Intrahepatic / pathology
  • Biliary Tract Neoplasms* / surgery
  • Cholangiocarcinoma* / diagnosis
  • Cholangiocarcinoma* / pathology
  • Cholangiocarcinoma* / therapy
  • Gallbladder Neoplasms* / surgery
  • Humans