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Conversion surgery for initially unresectable biliary malignancies: a multicenter retrospective cohort study

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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 < 0.001).

Conclusion

Conversion surgery for initially unresectable biliary malignancies may be feasible and achieve long-term survival for selected patients.

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Acknowledgements

We thank all members of the HOCS study team and the members of the Departments of Surgery of Hokkaido University, Sapporo Medical University, and Asahikawa Medical University.

Funding

Authors’ own resources.

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Authors and Affiliations

  1. Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan

    Takehiro Noji, Keikuke Okamura & Satoshi Hirano

  2. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan

    Minoru Nagayama, Masafumi Imamura & Yastoshi Kimura

  3. Department of Surgery, Asahikawa Medical University, Asahikawa, Japan

    Koji Imai

  4. Gastroenterology, Hokkaido University Faculty of Medicine, Sapporo, Japan

    Yasuyuki Kawamoto & Masaki Kuwatani

Authors
  1. Takehiro Noji
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  2. Minoru Nagayama
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  3. Koji Imai
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  4. Yasuyuki Kawamoto
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  5. Masaki Kuwatani
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  6. Masafumi Imamura
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  7. Keikuke Okamura
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  8. Yastoshi Kimura
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  9. Satoshi Hirano
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Contributions

TN wrote the manuscript. TN, MN, KI, MI, KO, MK, and YK collected data. YK and SH were responsible for the study design and manuscript revision.

Corresponding author

Correspondence to Takehiro Noji.

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Conflict of interest

We have no conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The ethics committees of Hokkaido University Hospital, Sapporo Medical University Hospital, and Asahikawa Medical University approved the study. Based on the national Japanese law and guidelines for clinical research, informed consent was not needed from participants included in the study. This study registration number is UMIN000035900.

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Supplementary file1 (DOCX 25 kb)

595_2020_2031_MOESM2_ESM.tif

Supplementary file2 Supplemental Figure: Overall survival after surgery based on the preoperative carcinoembryonic antigen (CEA) level. There were significant differences in overall survival based on the CEA level (p < 0.001). CEA, carcinoembryonic antigen (TIF 298 kb)

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Noji, T., Nagayama, M., Imai, K. et al. Conversion surgery for initially unresectable biliary malignancies: a multicenter retrospective cohort study. Surg Today 50, 1409–1417 (2020). https://doi.org/10.1007/s00595-020-02031-5

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  • DOI: https://doi.org/10.1007/s00595-020-02031-5

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