title: Review article: surgical, neo-adjuvant and adjuvant management strategies in biliary tract cancer.
abstract: BACKGROUND
  The 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.
  
  
  OBJECTIVE
  To review the current evidence base for surgical, adjuvant and neo-adjuvant techniques in the management of cholangiocarcinoma.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Data 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Surgery and Interventional Science, University College London, UK. j.skipworth@ucl.ac.uk
authors.forename: J R A
authors.initials: JR
authors.lastname: Skipworth
authors.forename: S W M
authors.initials: SW
authors.lastname: Olde Damink
authors.forename: C
authors.initials: C
authors.lastname: Imber
authors.forename: J
authors.initials: J
authors.lastname: Bridgewater
authors.forename: S P
authors.initials: SP
authors.lastname: Pereira
authors.forename: M
authors.initials: M
authors.lastname: Malagó
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D018281:Cholangiocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents