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Introduction The centralization of cancer care in metropolitan hospitals has led to disparities in treatment accessibility, particularly for biliary tract cancer patients. While centralization may benefit complex surgical cases, its impact on non-surgical patients remains unclear.Methods This study analyzed a retrospective multicenter real-world dataset of 2,812 biliary tract cancer patients from four tertiary hospitals in Korea. Patients were categorized based on surgical eligibility and treatment type, and survival outcomes were assessed using Kaplan-Meier survival analysis and Cox proportional hazard models. Statistical significance was set at p<0.05.Results Median survival was significantly higher for surgical patients treated at a high-volume metropolitan hospital (1,028 days) compared to regional hospitals (ranging from 593 to 778 days, p=0.021). However, among non-surgical patients, no significant survival differences were observed across hospitals (p=0.158). Also, chemotherapy showed no statistically significant survival benefit over palliative care (p=0.229), with survival rates being consistent across institutions.Conclusions While complex surgical cases may benefit from high-volume hospitals, non-surgical treatment outcomes appear comparable across institutions, supporting the feasibility of decentralized cancer care.