Treatment Strategies for Biliary Tract Cancer: A Surgical Perspective from Historical Evolution to Neoadjuvant Therapy

BACKGROUND: Biliary tract cancer (BTC) is an aggressive malignancy with poor prognosis despite curative resection, necessitating multidisciplinary treatment strategies beyond surgery alone. METHODS: This narrative review summarizes pivotal clinical trials and guideline-defining studies on adjuvant and neoadjuvant therapies, including BILCAP, BCAT, PRODIGE 12, and ASCOT. RESULTS: Adjuvant chemotherapy, particularly capecitabine, has become standard after resection, although optimal regimens remain controversial. Neoadjuvant therapy shows promise for improving patient selection and R0 resection rates, but evidence is limited. CONCLUSIONS: BTC management has evolved toward a biology-driven, multidisciplinary approach, with surgeons playing a central role in treatment sequencing.