Biliary tract carcinoma

Opinion statement  

–	The key to successful management of biliary tract carcinoma is early diagnosis and a multidisciplinary team approach involving a hepatobiliary surgeon, therapeutic endoscopist, and oncologist.
–	Management depends on the location of the tumor ( proximal or distal), and resectability.
–	Distal tumors that are resectable are best treated with radical pancreaticoduodenectomy, while nonresectable distal tumors are treated by using endoscopic or percutaneous biliary stents for biliary decompression.
–	Treatment of proximal resectable tumors depends on the Bismuth Classification. Bismuth I and II tumors can be resected without concomitant hepatic resection, and Bismuth III and IV tumors require local tumor and hepatic parenchymal resection. Nonresectable proximal tumors are best treated with percutaneous transhepatic biliary stents.
–	The role of chemotherapy, radiotherapy, and photodynamic therapy in these patients remains investigational.