Journal: Nature reviews. Clinical oncology
This review article examines evolving perioperative management strategies for biliary tract cancers, including intrahepatic, perihilar, and distal cholangiocarcinoma, as well as gallbladder cancer.
It emphasizes that these are biologically heterogeneous, highly aggressive tumors, with most patients presenting with unresectable disease and experiencing high recurrence rates even after surgery.
The authors discuss several key developments:
- Expanded surgical options: Selected use of liver transplantation and improved integration of locoregional therapies (such as liver-directed treatments) with systemic therapy have increased the number of patients eligible for potentially curative surgery.
- Systemic therapies moving earlier: Immune-checkpoint inhibitors and targeted agents, originally developed for advanced disease, are now being investigated in earlier-stage and perioperative settings.
- Need for individualized, multidisciplinary care: Because of disease complexity and heterogeneity, treatment algorithms are not straightforward and require close collaboration among hepatobiliary surgeons, oncologists, interventional radiologists, and transplant teams.
- Biomarker-driven patient selection: Future progress will depend on better molecular profiling and biomarker strategies to:
- • Tailor systemic therapy choices
- • Refine criteria for surgical resection and transplantation
- • Identify which patients derive meaningful benefit from specific perioperative approaches
The review concludes that optimizing outcomes will require global collaboration and innovative clinical trial designs to better define and validate these emerging perioperative strategies for biliary tract cancers.