title: Surgical resection after downsizing chemotherapy for initially unresectable locally advanced biliary tract cancer: a retrospective single-center study.
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.
authors.affiliation: Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. akato@faculty.chiba-u.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshidome
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: Katsunori
authors.initials: K
authors.lastname: Furukawa
authors.forename: Dan
authors.initials: D
authors.lastname: Takeuchi
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Takayashiki
authors.forename: Fumio
authors.initials: F
authors.lastname: Kimura
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic; D001653:Bile Ducts, Intrahepatic; D002277:Carcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D018281:Cholangiocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005706:Gallbladder Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine