Conversion therapy for initially unresectable gallbladder cancer after combination chemotherapy with gemcitabine and cisplatin

A 61-year-old woman with a chief complaint of epigastric discomfort was referred to our hospital. Contrastenhanced CT revealed a tumor in the gallbladder and swelling of lymph nodes with arterial invasion in the hepatic hilar region. Thus, the patient was diagnosed with unresectable gallbladder cancer and underwent chemotherapy with gemcitabine and cisplatin administered on a 3-week schedule (2 weeks on/1 week off: GC therapy). After 4 courses of GC therapy, the lymph nodes, which were considered having hepatic artery involvement, almost completely disappeared. In exploratory laparoscopy, there were no unresectable factors such as liver metastasis and peritoneal metastasis. Therefore surgical resection was performed. Operative findings revealed that the primary tumor did not invade the serosa of the gallbladder and hepatic parenchyma, and extensive fibrosis of lymph nodes. To minimize surgical stress and resume the chemotherapy early after the operation, we chose extended cholecystectomy with resection of extra-hepatic bile duct and regional lymphadenectomy. Small quantities of viable cells in resected lymph nodes were pathologically observed. However, there were no residual carcinoma cells at the surgical margin. We performed adjuvant chemotherapy with GC therapy for 12 courses. The patient remains alive and well at present, 24 months after the operation. In conclusion, we experienced the rare case of conversion therapy for initially unresectable gallbladder cancer after GC therapy.