Perihilar cholangiocarcinoma: Current therapy

Table 2 Criteria for unresectability[15]

Patient factors

Medically unfit or otherwise unable to tolerate a major operation

Hepatic cirrhosis

Local tumor-related factors

Tumor extension to secondary biliary radicles bilaterally

Encasement or occlusion of the main portal vein proximal to its bifurcation

Atrophy of one hepatic lobe with contralateral portal vein branch encasement or occlusion

Atrophy of one hepatic lobe with contralateral tumor extension to secondary biliary radicles

Unilateral tumor extension to secondary biliary radicles with contralateral portal vein branch

encasement or occlusion

Metastatic disease

Histologically proven metastases to N2 lymph nodes1

Lung, liver, or peritoneal metastases

¹Metastatic disease to peripancreatic, periduodenal, celiac, superior mesenteric, or posterior pancreaticoduodenal lymph nodes was considered to represent disease not amenable to a potentially curative resection. By contrast, metastatic disease to cystic duct, pericholedochal, hilar, or portal lymph nodes (i.e., within the hepatoduodenal ligament) did not necessarily constitute unresectability.