National consensus on a new resectability classification for perihilar cholangiocarcinoma - A modified Delphi method

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Background:

• Lack of standardized definitions for resectable, borderline, and unresectable perihilar cholangiocarcinoma (pCCA).
• Need for clear criteria to guide patient selection for neoadjuvant or induction therapy studies in pCCA.

Purpose of the Study:

• To establish practical criteria for classifying pCCA resectability.
• To develop a classification system for patient stratification in future neoadjuvant therapy trials.

Main Methods:

• Modified DELPHI method employed with hepatobiliary surgeons from Dutch tertiary referral centers.
• Five online meetings and two surveys were conducted to discuss and reach consensus on resectability factors.
• Focus on vascular involvement of the future liver remnant (FLR) and feasibility of radical biliary resection.

Main Results:

• Consensus reached on 63% of the discussed statements after two surveys.
• Definition of clearly resectable pCCA: no significant vascular involvement (≤90°) of FLR and feasible radical biliary resection.
• Definition of clearly unresectable pCCA: non-reconstructable vascular involvement of FLR or non-feasible radical biliary resection.
• Borderline resectable pCCA defined as cases falling between clearly resectable and unresectable.

Conclusions:

• A practical and applicable classification for pCCA resectability (or explorability) was developed.
• This classification system facilitates patient categorization for neoadjuvant therapy studies.
• The study provides a foundation for more consistent and effective treatment planning in pCCA.