Background: 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. Methods: 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. Results: 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%,p< 0.001). Conclusions: 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.
背景：鉴于单纯化疗在治疗不可切除胆道癌中的疗效有限，我们对化疗降期有效的不可切除胆道癌患者实施了转化手术。方法：本研究纳入2007年至2018年间开始化疗的不可切除胆道癌患者，评估接受转化手术的初始不可切除胆道癌患者的近期与远期疗效。结果：共101例接受化疗的不可切除胆道癌患者符合研究条件，其中20例最终接受转化手术。这些患者中局部晚期6例、肝转移6例、主动脉旁淋巴结转移5例、腹膜播散3例。平均手术时间823分钟，平均术中失血量1902毫升。17例患者实现组织学R0切除，10例患者出现Clavien-Dindo IIIa级及以上术后并发症，无手术相关死亡。接受转化手术患者的5年生存率（65.0%）显著高于未手术患者（4.3%，p<0.001）。结论：针对初始不可切除胆道癌的转化手术虽具有较高手术侵袭性，但能安全实施并获得良好总生存期，值得临床考虑。
肿瘤(癌症)患者之家