Surgery combined with chemoradiotherapy increases survival in patients with extrahepatic cholangiocarcinoma (eCCA), according to the results of a new study published in the Annals of Hepatobilliary Pancreatic Surgery. Lymph node resection, bile duct excision, lobectomy, and hepatectomy have better outcomes, according to the study.

To assess the survival outcomes in patients with eCCA, a team of researchers led by Saurabh Agrawal, MD, from the Department of Hepatology, Tampa General Hospital in Tampa, Florida, analyzed data from the Surveillance, Epidemiology, and End Results (SEER) registry from 2000 to 2018. 

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When they compared the years 2000 to 2006 to the year 2013, the researchers found that survival increased. The team also reported that surgery with chemoradiotherapy and surgery with chemotherapy improved patient survival compared to surgery alone. 

Surgery of at least 4 regional lymph nodes reduced the risk of death by 58% compared to surgery without the removal of lymph nodes. 

Bile duct excision, simple or extended lobectomy, and hepatectomy also significantly improved survival compared to no surgery. 

The researchers also reported that patients with distal cholangiocarcinoma (dCCA) had 17% higher survival than those with perihilar cholangiocarcinoma. Lymph node dissection benefited patients with both types of disease equally.

“Surgery with chemoradiotherapy remains the treatment modality with a demonstrated increase in 5-year survival,” the researchers concluded.

Cholangiocarcinoma is a heterogeneous group of rare malignant tumors originating from cells of the biliary tree. Based on its anatomical origin, cholangiocarcinoma is divided into 2 subgroups: intrahepatic and extrahepatic. eCCA is further divided into pCCA and dCCA. The different types of cholangiocarcinoma also differ from one another in terms of etiology, pathogenesis, epidemiology, clinical presentation, prognosis, and treatment.

The SEER registry is a program supported by the National Cancer Institute, which provides information on cancer statistics with the aim of reducing the cancer burden in the US.


Ali H, Zweigle J, Patel P, Tedder B, Khan R, Agrawal S. Survival analysis of extrahepatic cholangiocarcinoma based on surveillance, epidemiology, and end results database. Ann Hepatobiliary Pancreat Surg. Published online January 2, 2023. doi:10.14701/ahbps.22-090