Surgical management of biliary tract cancers

Biliary tract cancers (BTC) are aggressive gastrointestinal malignancies that are associated with a poor prognosis. This rare group of tumors includes cancers of the gallbladder, intrahepatic, and extrahepatic biliary tree. Chronic inflammatory processes such as cholelithiasis and chronic bacterial infection of the biliary system remain the most common underlying risk factor although most cases occur sporadically. The majority of patients present with advanced disease accompanied by nonspecific symptoms, making BTCs a therapeutic challenge for clinicians. In patients with localized, resectable disease, the only potentially curative treatment is a complete resection with negative microscopic margins. Liver transplantation has been used in selected patients with peri-hilar cholangiocarcinoma, with acceptable results. Recurrence rates remain high despite surgical treatment and 5-year survival rates range from 8-40% in patients treated with resection. In this review, we will summarize the current surgical management strategies for BTCs, focusing on the role of resection.