Introduction : Surgical resection is necessary to achieve a cure for bile duct cancer (BDC). However, not few BDC patients are initially unresectable. The aim of the present study was to reveal efficacy of conversion surgery after chemotherapy for patients with initially unresectable BDC (IURBDC).

Methods : IURBDC patients between July 2007 and February 2017 were included. Responders to chemotherapy for at least 6 months underwent conversion surgery. Definition of IURBDC: BDC with extended bile duct invasion, severe and unreconstructable arterial, portal, or hepatic venous invasion, invasion to IVC, distant metastasis, or inefficient hepatic reserve.

Results : Eighty-seven IURBDC patients were treated with chemotherapy. Conversion surgery was performed in 18 (20.7%) patients. Details of these patients are the followings. The average age: 67 y.o. Intrahepatic cholangiocarcinoma (n=6), perihilar cholangiocarcinoma (n=8), distal BDC (n=1), gallbladder cancer (n=2), and ampullary cancer (n=1). The reasons for unresectability were hepatic venous invasion (n=4), arterial or portal invasion (n=4), and distant metastasis (n=10). Chemotherapy: GS (n=6), GC (n=10), and GEM alone (n=2) with the median administration period of 10 months. Response: PR (n=7) and SD (n=11). Surgical procedures: major hepatic resection (n=12), pancreaticoduodenectomy (n=2), and limited surgery (n=4). Curative resection was achieved in 15 patients. Postoperative complications (≧grade IIIa) occurred in 7 patients. No patient died of complications. Overall survival rate was significantly higher in patients who underwent conversion surgery than those who did not (3 year: 81.9% vs 14.2%, p <0.001).

Conclusions : The present study suggested that conversion surgery prolonged overall survival and was safely performed for patients with IURBDC.