[Present situation of and prospects for standardization of surgery for biliary tract cancer]

Surgery remains the primary treatment for biliary tract malignancies. A standard therapy is required in the era of evidence-based medicine. However, guidelines for biliary tract cancer surgery have not yet been adopted. We review the current literature on the treatment of biliary tract malignancies and surveyed the prospects for standardization of biliary tract cancer surgery. For patients with gallbladder cancer, surgical procedures should be selected based on the depth of invasion. In aggressive surgery for stage IV gallbladder cancer, attention should be paid to the high incidence of operative mortality. Hepatopancreatoduodenectomy and extended lymph node dissection have been investigated in clinical trials. For hilar cholangiocarcinoma patients, surgical procedures should be selected based on tumor location. For Bismuth types III and IV, hepatectomy combined with caudate lobectomy appears to be the standard surgery. Liver transplantation for hilar cholangiocarcinoma patients is currently being examined in clinical trials. Pancreatoduodenectomy is considered the standard procedure for middle and lower bile duct and ampullary cancer. It is necessary to continue developing adjuvant therapies for patients with negative prognostic factors. The appropriateness of adjuvant therapies such as chemotherapy and radiation therapy should be confirmed in further clinical trials. It is necessary to reach a definite consensus on standard therapy for biliary tract malignancies in the near future, and therefore multicenter, randomized trials to address the issues involved should be initiated in Japan.