Over the past two decades, dramatic changes have occurred in medicine and, in particular, in the field of hepatopan‐creatobiliary diseases. With respect to cancer, the role that oncogenes and tumour suppressor genes play in pathogenesis has become apparent. With respect to imaging, computerised tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have all evolved substantially. Similarly, interventional radiology and endoscopy have come of age. At the same time, the ability to perform safe liver surgery and transplantation has become routine. In addition, major advances have occurred in the more focal delivery of radiotherapy as well as in the modes of delivery and in the array of available chemotherapeutic agents. Despite these major advances, the overall outcome of patients with gallbladder and bile duct malignancies has not changed significantly over the same time period.