Background : Advancement of chemotherapy is allowing for implementation of conversion and salvage therapy for various cancers; however, a little is known for biliary tract caner (BTC). This study aimed to evaluate the outcome of conversion and salvage surgery in patients with BTC.

Methods : Data of 541 consecutive patients who underwent surgical resection for BTC from 2000 to 2022 were retrospectively reviewed. Conversion surgery was defined as the surgery for initially unresectable disease; whereas, salvage surgery was defined as the surgery for recurrent disease. Clinicopathological features and survival outcomes were evaluated.

Results : The conversion group comprised 12 patients (2.2%), including 5 with perihilar cholangiocarcinoma, 5 with intrahepatic cholangiocarcinoma and 2 with gallbladder cancer. Aggressive lymph node involvement (n=8) was the main reason for initially unresectability. The median duration of chemotherapy to surgery was 5.0 months (range, 2.4-18.5 months), with a post-surgery survival time of 44.1 months (range, 10.7-103.3 months). During the study period, 291 patients exhibited tumor recurrence and 29 patients (10.0%) underwent salvage surgeries. The most frequent site amenable for salvage surgery was liver (n=15) followed by lung (n=8), and solitary lymph nodes (n=3). Out of the 29 patients, 12 patients (41.4%) underwent chemotherapy before the surgery, with a median duration of chemotherapy to surgery being 6.0 months (range, 1.9-65.4 months). The median survival after recurrence was 59.7 months (range, 29.2-146.9 months) in these patients.

Conclusions : Conversion and salvage surgery may offer the potential for prolonged survival in advanced or recurrent BTC.