Skip to main content

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



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.


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.


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).


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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, Madhusudan S, Iveson T, Hughes S, Pereira SP, Roughton M, Bridgewater J. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362(14):1273–1281.

    PubMed  Article  CAS  Google Scholar 

  2. Valle JW, Wasan H, Johnson P, Jones E, Dixon L, Swindell R, Baka S, Maraveyas A, Corrie P, Falk S, Gollins S, Lofts F, Evans L, Meyer T, Anthoney A, Iveson T, Highley M, Osborne R, Bridgewater J. Gemcitabine alone or in combination with cisplatin in patients with advanced or metastatic cholangiocarcinomas or other biliary tract tumours: a multicentre randomised phase II study—The UK ABC-01 Study. Br J Cancer. 2009;101(4):621–627.

    PubMed  Article  CAS  Google Scholar 

  3. Eckel F, Schmid RM. Chemotherapy in advanced biliary tract carcinoma: a pooled analysis of clinical trials. Br J Cancer. 2007;96(6):896–902.

    PubMed  Article  CAS  Google Scholar 

  4. Nelson JW, Ghafoori AP, Willett CG, Tyler DS, Pappas TN, Clary BM, Hurwitz HI, Bendell JC, Morse MA, Clough RW, Czito BG. Concurrent chemoradiotherapy in resected extrahepatic cholangiocarcinoma. Int J Radiat Oncol Biol Phys. 2009;73(1):148–153.

    PubMed  Article  CAS  Google Scholar 

  5. Nathan H, Pawlik TM, Wolfgang CL, Choti MA, Cameron JL, Schulick RD. Trends in survival after surgery for cholangiocarcinoma: a 30-year population-based SEER database analysis. J Gastrointest Surg. 2007;11(11):1488–1496; discussion 1496–1487.

    PubMed  Article  Google Scholar 

  6. Murakami Y, Uemura K, Hayasidani Y, Sudo T, Hashimoto Y, Ohge H, Sueda T. Indication for postoperative adjuvant therapy in biliary carcinoma based on analysis of recurrence and survival after surgical resection. Dig Dis Sci. 2009;54(6):1360–1364.

    PubMed  Article  CAS  Google Scholar 

  7. Eckel F, Jelic S. Biliary cancer: ESMO clinical recommendation for diagnosis, treatment and follow-up. Ann Oncol. 2009;20 Suppl 4:46–48.

    PubMed  Google Scholar 

  8. Wolpin BM, Mayer RJ. A step forward in the treatment of advanced biliary tract cancer. N Engl J Med. 2010;362(14):1335–1337.

    PubMed  Article  CAS  Google Scholar 

  9. Seehofer D, Thelen A, Neumann UP, Veltzke-Schlieker W, Denecke T, Kamphues C, Pratschke J, Jonas S, Neuhaus P. Extended bile duct resection and [corrected] liver and transplantation in patients with hilar cholangiocarcinoma: long-term results. Liver Transpl. 2009;15(11):1499–1507.

    PubMed  Article  Google Scholar 

  10. Hernandez J, Cowgill SM, Al-Saadi S, Villadolid D, Ross S, Kraemer E, Shapiro M, Mullinax J, Cooper J, Goldin S, Zervos E, Rosemurgy A. An aggressive approach to extrahepatic cholangiocarcinomas is warranted: margin status does not impact survival after resection. Ann Surg Oncol. 2008;15(3):807–814.

    PubMed  Article  Google Scholar 

  11. Murakami Y, Uemura K, Hayashidani Y, Sudo T, Hashimoto Y, Ohge H, Sueda T. Prognostic significance of lymph node metastasis and surgical margin status for distal cholangiocarcinoma. J Surg Oncol. 2007;95(3):207–212.

    PubMed  Article  Google Scholar 

  12. Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, Nagakawa T, Nakayama T. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer. 2002;95(8):1685–1695.

    PubMed  Article  Google Scholar 

Download references


This research is supported in part by the National Institutes of Health through MD Anderson’s Cancer Center Support grant CA016672 and partially funded by an NIH T32 training grant CA09599 (ESG). The authors extend our appreciation to Kristine Ash and Vickie Ellis for administrative support on this project.

Conflict of interest

The authors declare that there are no conflicts of interest.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Steven A. Curley.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Glazer, E.S., Liu, P., Abdalla, E.K. et al. Neither Neoadjuvant nor Adjuvant Therapy Increases Survival After Biliary Tract Cancer Resection with Wide Negative Margins. J Gastrointest Surg 16, 1666–1671 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Cholangiocarcinoma
  • Resection
  • Neoadjuvant
  • Adjuvant