Conversion surgery for initially unresectable biliary malignancies: a multicenter retrospective cohort study
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ORIGINAL ARTICLE
Conversion surgery for initially unresectable biliary malignancies: a multicenter retrospective cohort study Takehiro Noji1 · Minoru Nagayama2 · Koji Imai3 · Yasuyuki Kawamoto4 · Masaki Kuwatani4 · Masafumi Imamura2 · Keikuke Okamura1 · Yastoshi Kimura2 · Satoshi Hirano1 Received: 24 September 2019 / Accepted: 23 April 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Few studies have focused on conversion surgery for biliary malignancy; thus, it is not clear if this treatment modality can extend the survival of patients with unresectable biliary malignancy. We conducted a multicenter retrospective cohort study to evaluate the surgical outcomes of conversion surgery in this setting and analyze long-term survival. Methods We collected clinical data retrospectively on patients who underwent conversion surgery for biliary malignancy. Results Twenty-four patients met our inclusion criteria. Preoperative chemotherapy regimens or chemoradiation therapy regimens were administered based on the institutional criteria, and surgical procedures were chosen based on tumor location. Morbidity occurred in 16 patients (66.7%), and 1 patient died of liver failure after surgery. The overall 5-year survival rate following initial therapy was 43.2%, and the median survival time was 57.4 months. The corresponding values following surgery were 38.2% and 34.3 months, respectively. The 5-year survival rate of the 24 patients who received both chemotherapy and surgery was significantly better than that of 110 patients treated with chemotherapy only (p 7.0 mg/dl) [10] and that of CA19-9 was based on the institutional limit (CA19-9 > 37). Postoperative follow-up data included the primary site of disease recurrence and the date of its detection, the date and cause of death, and the date of last follow-up. The observation period was defined as the time from initial treatment to the date of death for censored patients or the last follow-up date for non-censored patients.
Diagnostic criteria for unresectability All primary tumors were diagnosed by histological examination. The diagnostic criteria for unresectability with local advancement were not defined by the HOCS group because each institution had its own criterion. The major difference between Hokkaido University and the other institutes was whether concomitant hepatic artery resection was performed. Hokkaido University did not consider a tumor to be unresectable because of hepatic
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arterial invasion, whereas the other institutes, including some referral hospitals, considered contralateral hepatic artery invasion unresectable. Patients who received neoadjuvant therapy as well as those with tumors that were initially considered resectable technically, but received anti-tumor therapy before surgery for various reasons, were excluded from this study. All patients with distant metastases were initially considered to have unresectable disease. Paraaortic lymph node (PAN) metastasis was also considered distant metastasis. Other hepatic lesions in patients
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