关键词: 晚期胆管癌, 胆囊癌, 转化治疗, 辅助治疗, 综合治疗, 免疫治疗, 靶向治疗, 化学治疗, 序贯手术治疗

Abstract: Critical issues in conversion therapy and sequential surgical management of gallbladder carcinoma        ZHAO Hai-tao, WANG Shan-shan. Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing 100730, China
Correspondence author： ZHAO Hai-tao, E-mail:zhaoht@
pumch.cn
Abstract    Conversion therapy holds promise in downstaging initially unresectable tumors, achieving R0 resection, affording patients a chance for surgery, and extending survival. With continuous advancements in systemic therapy and comprehensive treatment modalities, conversion therapy for gallbladder cancer (GBC) has emerged as a hot topic of investigation. In formulating a comprehensive conversion strategy for GBC, it is critical to acknowledge the intrinsic heterogeneity observed in GBC and avoid a simplistic adherence to established guidelines. Instead, keeping pace with international advancements and maintaining a profound comprehension of the implications of various treatment approaches and assessment metrics are pivotal for achieving highly individualized strategies. The future holds promising prospects for the application of the Immunotherapy Prototype Mark 3.0 model in GBC conversion therapy. Nevertheless, vigilant surveillance and timely recognition of immunotherapy-related adverse events during the perioperative period assume paramount importance. Several crucial questions are yet to be thoroughly investigated, such as population selection, formulation of conversion strategies, and optimal timing for sequential surgery, as basic and clinical research cannot currently meet the requirements of real-world clinical practice. In light of this context, the author encourages experts from various fields to actively summarize experiences, enhance collaboration, and engage in prospective multicenter studies on preoperative conversion and postoperative adjuvant therapy, with the aim of forming a consensus on GBC conversion therapy with distinct Chinese characteristics.

Key words: advanced biliary tract cancer, gallbladder cancer, conversion therapy, adjuvant therapy, comprehensive treatment, immunotherapy, targeted therapy, chemotherapy, sequential surgery