Treatment of borderline cases for curative resection of biliary tract cancer

Background and Aim To dissect the high rate of non-curative resection associated with biliary tract caner, we compared the outcome of non-curative resection with that of inoperable cancer in patients referred for surgery. Methods: We retrospectively analyzed 447 patients with biliary tract cancer who were referred to our hospital between 1970 and 2008. We compared the background and overall survival (OS) rates accordingly to surgery (curative resection, non-curative resection, or no surgery "inoperable") and alternative therapies (chemotherapy and/or radiotherapy). Results The 3-year OS rate was 19% for the non-curative resection group (n = 72) and 2% for the inoperable group (n = 135, P<0.0001). Among the inoperable cases, the 3-year OS rate for patient who received chemotherapy, including gemcitabine (GEM), was 18% (n = 18), which was similar to that of patients of the non-curative resection who were treated with GEM (P = 0.7379). There were no significant differences in survival between non-curative resection without GEM and inoperable cases with GEM-based chemotherapy. Conclusion Our results indicate that the prognosis of patients who undergo non-curative surgery is better than those with inoperable cancer, but similar to those who receive chemotherapy including GEM.