What is the management of resected cholangiocarcinoma in terms of intra- and postoperative status of tumor margins and lymph nodes? A current view

In recent years, the therapeutic management of cholangiocarcinoma (intrahepatic, perihilar and distal; composed by the term biliary tract cancer (BTC)) has continuously changed based on our ‘dramatical’ increased knowledge of molecular carcinogenetic mechanism of this cancer entity with a still alarming mortality [1]. The decisive key to the long-term therapeutical success of BTC is still the complete resectability depending mainly on the first clinical presentation of each patient. Thus, pre-surgical diagnostic as well as intraand post-operative tumor staging are of high importance. In case of possible resection of BTCs, the post-operative therapeutic strategy is subject of intensive clinical investigations leading to new, possibly controversial recommendations in recent years [2]. This commentary of the Expert Review of Gastroenterology & Hepatology tries to evaluate different aspects and to answer arising questions on, how margin and nodal status of resectable BTCs should influence the postsurgical choice and intensity of treatment strategy from a pathological and clinical view. Here, the commentary will focus on the following three issues of published clinical studies dealing with (i) surgical therapy in relation to (ii) resection status and (iii) adjuvant therapeutic options in BTCs, which are summarized in Figure 1, too.