Survival benefit of conversion surgery for initially unresectable biliary tract cancer: a systematic review and meta-analysis.

PURPOSE: Combination of gemcitabine and cisplatin (GemCis) is the current first-line treatment for unresectable biliary tract cancer (UR-BTC), but it confers a median overall survival (OS) of less than one year. This study aimed to evaluate the survival benefit of conversion surgery for initially UR-BTC.

METHODS

Eligible studies published between January 2000 and May 2024 were identified via an electronic search of PubMed and Web of Science databases. The primary endpoint was OS.

RESULTS

Included in this study were 96 observational studies involving 466 patients with 231 cases (49.6%) of intrahepatic cholangiocarcinoma, 131 cases of (28.1%) extrahepatic cholangiocarcinoma, and 104 cases (22.3%) of gallbladder cancer. The 90-day mortality rate was 4.3%, and the median survival duration was 36.8 (17.9-57.6) months, with a 1-, 3- and 5-year OS rate of 86% (74-95.9%), 59.9% (32.3-78.7%), and 41.1% (24-58.5%) respectively. Meta-analysis showed that survival in patients who underwent conversion surgery was significantly higher than that in those who received non-surgical treatment (hazard ratio [HR] 0.39, P < 0.001) and comparable to that in those who underwent up-front surgery for resectable cancer (HR 1.02, P = 0.43). Pooled analysis of 149 individual participant data showed that male gender (HR 20.649, P = 0.014) and lymph node metastasis (HR 14.671, P = 0.005) were independently associated with reduced OS.

CONCLUSION

Conversion surgery is justified in initially UR-BTC with favorable long-term survival, and may prove to be a promising option for the multimodality treatment of UR-BTC.