TY - JOUR
T1 - National consensus on a new resectability classification for perihilar cholangiocarcinoma - A modified Delphi method
AU - Nooijen, Lynn E.
AU - de Boer, Marieke T.
AU - Braat, Andries E.
AU - Dewulf, Maxime
AU - den Dulk, Marcel
AU - Hagendoorn, Jeroen
AU - Hoogwater, Frederik J. H.
AU - Lam, Hwai-Ding
AU - Molenaar, Quintus
AU - Neumann, Ulf
AU - Porte, Robert J.
AU - Swijnenburg, Rutger-Jan
AU - Zonderhuis, Babs
AU - Kazemier, Geert
AU - Klümpen, Heinz-josef
AU - van Gulik, Thomas
AU - Groot Koerkamp, Bas
AU - Erdmann, Joris I.
N1 - Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Lynn Nooijen reports financial support was provided by Amsterdam Gastroenterology Endocrinology Metabolism. Publisher Copyright: © 2023 The Authors
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - Delphi study
KW - Neoadjuvant chemotherapy
KW - Perihilar cholangiocarcinoma
KW - Resectability classification
UR - http://www.scopus.com/inward/record.url?scp=85174714646&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2023.107117
DO - https://doi.org/10.1016/j.ejso.2023.107117
M3 - Article
C2 - 37880001
SN - 0748-7983
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
M1 - 107117
ER -