Murakami Takashi, Matsuyama Ryusei, Yabushita Yasuhiro, Homma Yuki, Sawada Yu, Miyake Kentaro, Kumamoto Takafumi, Takeda Kazuhisa, Maeda Shin, Yamanaka Shoji, Endo Itaru
Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan.
Department of Gastroenterology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan.
Cancers (Basel). 2025 Mar 3;17(5):873. doi: 10.3390/cancers17050873.
Due to the limited efficacy of chemotherapy alone in the treatment of unresectable biliary tract cancer, we performed conversion surgery in patients with unresectable biliary tract cancer who responded to down-staging chemotherapy.
Patients with unresectable biliary tract cancer who initiated chemotherapy between 2007 and 2018 were included in this study. We evaluated the short- and long-term outcomes of patients with initially unresectable biliary tract cancer who underwent conversion surgery.
A total of 101 patients with unresectable biliary tract cancers treated with chemotherapy were eligible for the present study. A total of 20 patients eventually underwent conversion surgery; these patients had locally advanced disease in 6 cases, liver metastasis in 6 cases, para-aortic lymph node metastasis in 5 cases, and peritoneal dissemination in 3 cases. The mean operative time was 823 min, and the mean intraoperative blood loss was 1902 mL. Histological R0 resections were performed in 17 patients. Postoperative complications of Clavien-Dindo grade IIIa or higher occurred in 10 patients, with no surgery-associated deaths. The 5-year survival rate was significantly higher in patients who underwent conversion surgery (65.0%) than in those who did not (4.3%, < 0.001).
Conversion surgery for initially unresectable biliary tract cancer resulted in favorable overall survival and was safely performed despite its high surgical invasiveness. Conversion surgery for an initially unresectable biliary tract cancer is worth considering.
由于单纯化疗在治疗不可切除的胆管癌方面疗效有限，我们对接受降期化疗后有反应的不可切除胆管癌患者进行了转化手术。
本研究纳入了2007年至2018年间开始化疗的不可切除胆管癌患者。我们评估了最初不可切除的胆管癌患者接受转化手术后的短期和长期结果。
共有101例接受化疗的不可切除胆管癌患者符合本研究条件。共有20例患者最终接受了转化手术；这些患者中，局部晚期疾病6例，肝转移6例，腹主动脉旁淋巴结转移5例，腹膜播散3例。平均手术时间为823分钟，平均术中失血量为1902毫升。17例患者进行了组织学R0切除。10例患者发生了Clavien-Dindo IIIa级或更高等级的术后并发症，无手术相关死亡。接受转化手术的患者5年生存率（65.0%）显著高于未接受转化手术的患者（4.3%，P<0.001）。
最初不可切除的胆管癌患者进行转化手术可带来良好的总生存率，尽管手术侵袭性高，但手术安全可行。最初不可切除的胆管癌患者进行转化手术值得考虑。
