Conversion Surgery for initially unresectable biliary malignancies. Multicenter retrospective cohort study

Abstract

Background: Recent reports showed surgery for patients with initially unresectable tumor (so called conversion surgery) could lead selected patients to long-term survival. However, because few reports on conversion surgery for biliary malignancies (intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, distal cholangiocarcinoma, gallbladder carcinoma, and papilla of Vater carcinoma) was reported, whether conversion surgery for biliary malignancies could lead long-term survival to patients with unresectable biliary malignancies were unclear. The purposes of this multicenter retrospective cohort study were, first to evaluate surgical results of conversion surgery, and second to evaluate long-term survival. Patients and Method: This study was enrolled by Hokkaido Cholangiocarcinoma study (HOCS) group. A multicenter survey was conducted to collect clinical data on patients with conversion surgery for biliary malignancies. Diagnostic criteria for unresectable with locally advanced were not defined. which were based on each institutional criterion. These were based on each institutional criterion. Para aortic lymph node metastasis were considered distant metastasis, and the other lesions in intrahepatic cholangiocarcinoma were also considered hepatic metastasis. Patients with distant metastasis were considered initially unresectable patients. Results: Twenty-four patients met our inclusion criteria. Median follow up duration from the initial therapy and from conversion surgery were 76.7months (10-163.1) and 70.1 months (0.8-157.1), respectively. Various preoperative chemotherapies or chemoradiation therapies were performed based on institutional criteria. Various surgical procedures were performed based on tumor location. Morbidity were occurred on 16 of 24 patients (66.7%), and one patient died after surgery (due to liver failure). Overall 5-year survival rate after initial therapy were 43.2%, and median survival time was 57.4 months. Overall 5-year survival rate after surgery were 37.9%, and also median survival time was 34.3months. Conclusion: Conversion surgery for initially unresectable biliary malignancies patients would be feasible, because selected patients could have long-term survival after the surgery.