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

Lynn E. Nooijen, Marieke T. de Boer, Andries E. Braat, Maxime Dewulf, Marcel den Dulk, Jeroen Hagendoorn, Frederik J.H. Hoogwater, Hwai Ding Lam, Quintus Molenaar, Ulf Neumann, Robert J. Porte, Rutger Jan Swijnenburg, Babs Zonderhuis, Geert Kazemier, Heinz josef Klümpen, Thomas van Gulik, Bas Groot Koerkamp, Joris I. Erdmann*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
21 Downloads (Pure)


Background: Currently, no practical definition of potentially resectable, borderline or unresectable perihilar cholangiocarcinoma (pCCA) is available. Aim of this study was to define criteria to categorize patients for use in a future neoadjuvant or induction therapy study. 

Method: Using the modified DELPHI method, hepatobiliary surgeons from all tertiary referral centers in the Netherlands were invited to participate in this study. During five online meetings, predefined factors determining resectability and additional factors regarding surgical resectability and operability were discussed. 

Results: The five online meetings resulted in 52 statements. After two surveys, consensus was reached in 63% of the questions. The main consensus included a definition regarding potential resectability. 1) Clearly resectable: no vascular involvement (≤90°) of the future liver remnant (FLR) and expected feasibility of radical biliary resection. 2) Clearly unresectable: non-reconstructable venous and/or arterial involvement of the FLR or no feasible radical biliary resection. 3) Borderline resectable: all patients between clearly resectable and clearly unresectable disease. 

Conclusion: This DELPHI study resulted in a practical and applicable resectability, or more accurate, an explorability classification, which can be used to categorize patients for use in future neoadjuvant therapy studies.

Original languageEnglish
Article number107117
Number of pages7
JournalEuropean Journal of Surgical Oncology
Publication statusAccepted/In press - 11-Oct-2023


  • Delphi study
  • Neoadjuvant chemotherapy
  • Perihilar cholangiocarcinoma
  • Resectability classification


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