Neither Neoadjuvant nor Adjuvant Therapy Increases Survival After Biliary Tract Cancer Resection with Wide Negative Margins

Background

We investigated the role of neoadjuvant/adjuvant therapies on survival for resectable biliary tract cancer. We hypothesized that neoadjuvant and adjuvant therapy should improve the survival probability in these patients.

Methods

This was a retrospective review of a prospective database of patients resected for gallbladder cancer (GBC) and cholangiocarcinoma (CC). One hundred fifty-seven patients underwent resection for primary GBC (n?=?63) and CC (n?=?94). Fisher??s exact test, Student??s t test, the log-rank test, and a Cox proportional hazard model determined significant differences.

Results

The 5-year overall survival rate after resection of GBC and CC was 50.6 % and 30.4?%, respectively. Of the patients, 17.8?% received neoadjuvant chemotherapy, 48.7?% received adjuvant chemotherapy, while 15.8?% received adjuvant chemoradiotherapy. Patients with negative margins of at least 1?cm had a 5-year survival rate of 52.4?% (p?<?0.01). Adjuvant therapy did not significantly prolong survival. Neoadjuvant therapy delayed surgical resection on average for 6.8?months (p?<?0.0001). Immediate resection increased median survival from 42.3 to 53.5?months (p?=?0.01).

Conclusions

Early surgical resection of biliary tract malignancies with 1?cm tumor-free margins provides the best probability for long-term survival. Currently available neoadjuvant or adjuvant therapy does not improve survival.