关键词: 胆囊癌, 局部进展期, 转化治疗, 循证医学, 化疗

Abstract: R0 resection after conversion treatment for recurrent gallbladder cancer according to evidence-based medicine: A case report and literature review        WU Xiang-song, YANG Zi-yi, GONG Wei. Department of General Surgery, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine； Shanghai Key Laboratory of Biliary Tract Disease Research；Shanghai Research Center of Tract Disease; Research Institute of Biliary Tract Disease, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Corresponding author：GONG Wei，E-mail：gongwei@xinhuamed.com.cn
WU Xiang-song and YANG Zi-yi are the first authors who contributed equally to the article.
Abstract    Objective    To develop a treatment plan based on evidence-based medicine for a case of locally advanced gallbladder cancer with postoperative recurrence. Methods    A 66-year-old woman with recurrent gallbladder cancer visited department of general surgery affiliated to Xin Hua Hospital in March 2020. Contrast-enhanced abdominal CT and FDG-PET confirmed metastatic lymph nodes around the main portal vein and the common hepatic artery. Multi-disciplinary team for biliary tract cancer evaluated the disease condition and searched evidences from the mainstream medical literature database. Finally, a conversion therapy strategy was formulated based on evidences and actual situation. Results    According to the evidences obtained, conversion therapy was performed. Patient received intravenous albumin-bound paclitaxel, 125 mg/m2, followed by gemcitabine, 1000 mg/m2, on days 1 and 8 of each 21-day treatment cycle. Partial remission was achieved after 4 cycles. Then R0 resection was performed successfully by wedge resection of gallbladder bed and lymphadenectomy and choledochojejunostomy. Postoperative pathology indicated complete remission. There was no recurrence after 6 months follow-up. Conclusion    For patients with recurrent gallbladder cancer, the resectability should be accurately assessed. For patients with no obvious benefit from upfront surgery, the conversion therapy strategy based on chemotherapy can be considered to achieve radical resection.

Key words: gallbladder cancer, locally advanced, conversion therapy, evidence-based medicine, chemotherapy