• Atsushi Kato, Hiroaki Shimizu, Masayuki Ohtsuka, Hiroyuki Yoshidome, Hideyuki Yoshitomi, Katsunori Furukawa, Dan Takeuchi, Tsukasa Takayashiki, Fumio Kimura, and Masaru Miyazaki.
• Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. akato@faculty.chiba-u.jp
• Ann. Surg. Oncol. 2013 Jan 1; 20 (1): 318-24.

BackgroundSurgical 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.MethodsInitially 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.ResultsChemotherapy 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.ConclusionsPreoperative 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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