Cholangiocarcinoma and gallbladder carcinoma are serious conditions with a poor prognosis. Cholangiocarcinoma can be divided in three main categories: intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma and distal cholangiocarcinoma. Incidence rates of cholangiocarcinoma are 6 per 100,000 individuals, while gallbladder carcinoma has an incidence of 2.5 in 100,000. Surgery is currently the only available treatment with curative potential. However, only a minority of the patients with gallbladder carcinoma or cholangiocarcinoma are eligible for surgery at the time of diagnosis.
After resection, survival varies considerably, indicating that large improvements can still be made with regard to risk profiling. Differentiation between individual patients, based on tumor-specific characteristics needs to be improved. Only using better differentiation and individualization methods, efforts can be made to improve survival and curation after resection of biliary malignancies. The primary goal of the Pearl is a joint investigation into differentiation and individualization methods in a prospective manner. In addition, specific targets for pre- and postoperative systemic therapy will be investigated.