Yadav S, et al. - Given a frequent use of chemotherapy in cholangiocarcinoma as an adjunct to surgical resection, researchers sought for the appropriate sequence of chemotherapy with surgery. Using the National Cancer Database, 1450 patients were identified who met the inclusion criteria, neoadjuvant chemotherapy was provided to 299 (20.6%) while 1151 (79.3%) received adjuvant chemotherapy. Matching 278 patients in the neoadjuvant group to 700 patients in the adjuvant group, they noted a superior overall survival (OS) in patients who received neoadjuvant chemotherapy compared to those who received adjuvant chemotherapy (Median OS: 40.3 vs 32.8 months). For the neoadjuvant chemotherapy group, the 1- and 5-year OS rates were 85.8% and 42.5% respectively compared to 84.6% and 31.7% for the adjuvant chemotherapy group. These findings indicate a longer OS in a select group of patients with cholangiocarcinoma in correlation with neoadjuvant chemotherapy compared to those who underwent upfront surgical resection followed by adjuvant chemotherapy.