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Multiphasic Evidential Decision-Making Matrix (MedMax) for Intrahepatic Cholangiocarcinoma: A Single-Center

Ali Ramouz¹, Ali Adeliansedehi¹, Behboud Moeini Chagervand¹

¹Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany.

|May 13, 2026

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The Multiphasic Evidential Decision-making Matrix (MedMax) accurately guides diagnosis and treatment for intrahepatic cholangiocarcinoma (ihCC). This evidence-based tool supports personalized strategies for both operable and non-operable ihCC patients.

Area of Science:

Hepatobiliary Surgery
Surgical Oncology
Medical Decision Support Systems

Background:

Intrahepatic cholangiocarcinoma (ihCC) is an aggressive liver cancer with increasing incidence and high recurrence rates after surgery.
Personalized, evidence-based clinical decision-making is crucial for improving outcomes in ihCC patients.
The Multiphasic Evidential Decision-making Matrix (MedMax) was developed to provide systematic, individualized therapeutic strategies for ihCC.

Purpose of the Study:

To evaluate the accuracy and reliability of the MedMax matrix in supporting treatment decisions for ihCC.
To assess MedMax's performance in both operable (surgical cohort) and non-operable (non-surgical cohort) patient groups.
To compare MedMax's recommendations with those made by a clinical tumor board.

Main Methods:

Keywords:

MedMax decision matrix individualized therapy intrahepatic cholangiocarcinoma retrospective validation surgical decision-making

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A retrospective single-center study of 489 consecutive ihCC patients (2010-2020).
Patients were divided into surgical (n=335) and non-surgical (n=154) cohorts.
Assessed MedMax's accuracy in diagnostic confirmation and treatment allocation, comparing its decisions with tumor board recommendations.

Main Results:

MedMax demonstrated high accuracy in diagnostic confirmation (100%) and treatment allocation (97.9% surgical, 98.7% non-surgical).
Concordance between MedMax and actual resection extent was 74.3% in the surgical cohort, due to unpredicted intraoperative findings.
Discrepancies with tumor board decisions in the non-surgical cohort were linked to complex patient profiles; MedMax effectively identified risk factors.

Conclusions:

The MedMax matrix offers accurate, reliable, and transparent decision-making for ihCC diagnosis and treatment.
Its modular, evidence-based approach supports individualized therapeutic strategies.
MedMax effectively stratifies and documents risks in both surgical and non-surgical ihCC management.