Abstract: Biliary tract cancer (BTC) is one of the malignant tumors with the fast-growing incidence globally. It exhibits an insidious onset, high malignancy, and poor 5‑year survival rate. Radical resection currently remains the only potentially curative treatment for BTC. However, a significant proportion of patients are often diagnosed at an advanced stage where radical resection is no longer feasible. In recent years, the development of novel agents has offered opportunities for surgery following conversion therapy. Nevertheless, surgical decision‑making after conversion therapy remains controversial, as it involves a complex balance of benefits and risks. Based on the latest evidence‑based medical evidence, the authors explore the value of surgery after conversion therapy for initially unresectable BTC from the perspectives of therapeutic benefits, risks, and prognostic implications, aiming to provide a scientific basis for clinical practice.