Conversion surgery for initially unresectable advanced biliary tract cancer

Abstract

Surgical resection remains to be the most effective treatment for biliary tract cancer and offers the only chance for the long-term survival. However, most cases are discovered at an advanced stage and curative resection is impossible in such cases. For patients with advanced unresectable disease, chemotherapy or chemoradiotherapy is usually indicated due to the recent improvement of effective chemotherapeutic agents. As a result, reports describing cases with initially unresectable biliary tract cancer underwent resection as a conversion surgery are increasing. In particular, in cases with intrahepatic cholangiocarcinoma or gallbladder carcinoma, a significant favorable outcome has been shown after conversion surgery, which could become one of the most important new therapeutic strategies. To establish this strategy, however, there are several problems to be solved, such as the definition of "unresectable", the determination of the best timing for the conversion, the development of more effective chemotherapeutic agents including molecular-targeted drugs, the discovery of the most suitable chemotherapeutic regimen, and the development of the method for assessment of susceptibility to drugs for each cancer.