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Surgical Resection after Downsizing Chemotherapy for Initially Unresectable Locally Advanced Biliary Tract Cancer: A Retrospective Single-center Study

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Surgical resection is the only method for curative treatment of biliary tract cancer (BTC). Recently, an improved efficacy has been revealed in patients with initially unresectable locally advanced BTC to improve the prognosis by the advent of useful cancer chemotherapy. The aim of this study was to evaluate the effect of downsizing chemotherapy in patients with initially unresectable locally advanced BTC.

Methods

Initially unresectable locally advanced cases were defined as those in which therapeutic resection could not be achieved even by proactive surgical resection. Gemcitabine was administered intravenously once a week for 3 weeks followed by 1 week’s respite. Patients whose disease responded to chemotherapy were reevaluated to determine whether their tumor was resectable.

Results

Chemotherapy with gemcitabine was provided to 22 patients with initially unresectable locally advanced BTC. Tumor was significantly downsized in nine patients, and surgical resection was performed in 8 (36.4%) of 22 patients. Surgical resection resulted in R0 resection in four patients and R1 resection in four patients. Patients who underwent surgical resection had a significantly longer survival compared with those unable to undergo surgery.

Conclusions

Preoperative chemotherapy enables the downsizing of initially unresectable locally advanced BTC, with radical resection made possible in a certain proportion of patients. Downsizing chemotherapy should be proactively carried out as a multidisciplinary treatment strategy for patients with initially unresectable locally advanced BTC with the aim of expanding the surgical indication.

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Authors and Affiliations

  1. Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan

    Atsushi Kato MD, PhD, Hiroaki Shimizu MD, PhD, Masayuki Ohtsuka MD, PhD, Hiroyuki Yoshidome MD, PhD, Hideyuki Yoshitomi MD, PhD, Katsunori Furukawa MD, PhD, Dan Takeuchi MD, PhD, Tsukasa Takayashiki MD, PhD, Fumio Kimura MD, PhD & Masaru Miyazaki MD, PhD

Authors
  1. Atsushi Kato MD, PhD
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  2. Hiroaki Shimizu MD, PhD
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  3. Masayuki Ohtsuka MD, PhD
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  4. Hiroyuki Yoshidome MD, PhD
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  5. Hideyuki Yoshitomi MD, PhD
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  6. Katsunori Furukawa MD, PhD
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  7. Dan Takeuchi MD, PhD
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  8. Tsukasa Takayashiki MD, PhD
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  9. Fumio Kimura MD, PhD
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  10. Masaru Miyazaki MD, PhD
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Corresponding author

Correspondence to Atsushi Kato MD, PhD.

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Kato, A., Shimizu, H., Ohtsuka, M. et al. Surgical Resection after Downsizing Chemotherapy for Initially Unresectable Locally Advanced Biliary Tract Cancer: A Retrospective Single-center Study. Ann Surg Oncol 20, 318–324 (2013). https://doi.org/10.1245/s10434-012-2312-8

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  • DOI: https://doi.org/10.1245/s10434-012-2312-8

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