Cholangiocarcinoma has a high mortality rate, and the incidence within the US and globally is rising. Currently, many patients are diagnosed at advanced stages due to non-specific symptoms and lack of standardized screening protocols, leading to limited surgical options and poorer outcomes. In ideal practice, early detection strategies, improved patient selection for surgery, enhanced perioperative optimization, and personalized molecular-guided therapies would be consistently applied, maximizing curative potential and long-term survival. 

Cholangiocarcinoma management is complex, from early diagnosis, optimal surgical approaches, perioperative care, and integration of molecular-targeted therapies. The gap in cholangiocarcinoma management exists due to the disease’s rarity, diagnostic challenges, rapidly evolving treatment landscape, and the need for multidisciplinary coordination. Limited awareness and lack of standardized screening protocols contribute to late-stage diagnoses, reducing the window for curative intervention. Additionally, advances in surgical techniques, perioperative optimization, and molecular-targeted therapies are not uniformly implemented due to variability in provider experience and institutional resources. There is a need to educate healthcare professionals on the latest evidence-based approaches, improve early detection, optimize surgical and perioperative care, and integrate molecular strategies, ultimately bridging the gap between current practice and ideal patient outcomes.