Clin Surg | Volume 6, Issue 1 | Research Article | Open Access

Postoperative Chemotherapy with Capecitabine for Biliary Tract Cancer? Quality and Risk Assessment of the BILCAP-Study

Giulia Manzini1,2*, Ursula Klotz2, Ian N Hines3, Doris Henne-Bruns2, Michael Kremer1 and Marietta Kirchner4

1Department of General and Visceral Surgery, Hospital of Aarau, Switzerland
2Department of General and Visceral Surgery, University Hospital of Ulm, Germany
3Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, USA
4Department of Medical Biometry and Informatics, University of Heidelberg, Germany

*Correspondance to: Giulia Manzini 

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According to the ASCO guidelines, patients with resected biliary tract cancer should be offered adjuvant capecitabine chemotherapy based on the results of the BILCAP trial. The aim of this evaluation is to assess quality of the BILCAP study. The BILCAP study was analyzed according to the Delphi and the CONSORT checklists. Risk of bias was assessed using the Cochrane risk of Bias Tool. On average, one patient was included every year by each center. The analysis was not adjusted for center. Treatment allocation by minimization was adopted but mode of application is poorly reported and the choice of variables not justified. No blinding was present. For the observed HR=0.81 with 234 events statistical power is only around 37%. Four of 9 items of the Delphi list and 6 of 35 items of the CONSORT checklist were not properly addressed. According to the Cochrane Risk of Bias Tool, the overall risk-of-bias judgment for the outcome overall survival of the BILCAP study was “some concerns”. Finally, the funding source had an advisory role in the study design. Based on the results of this study there is insufficient evidence for the administration of adjuvant chemotherapy with capecitabine in patients with biliary tract cancer.


Liver surgery; Validity; Adjuvant chemotherapy; Cholangiocellular carcinoma; Gallbladder carcinoma


Manzini G, Klotz U, Hines IN, Henne- Bruns D, Kremer M, Kirchner M. Postoperative Chemotherapy with Capecitabine for Biliary Tract Cancer? Quality and Risk Assessment of the BILCAP-Study. Clin Surg. 2021; 6: 3319.

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