Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma

Table 3 Criteria that can be used to identify non-resectable patients

Absolute criteria	Relative criteria
	Criteria	Suggestions
Presence of distant metastasis (especially liver, lung, peritoneum)	Longitudinal and lateral dissemination	Consider adequate staging (avoid R1-2)
Extra-regional lymphnode involvement (para-aortic and extraperitoneal)
Bilateral intrahepatic involvement of biliary tree that exclude bilio-enteric anastomosis	Portal infiltration < 2 cm	Portal vein resection needed
Infiltration or occlusion of the main portal trunk proximal to bifurcation
Right lobe atrophy associated to contralateral portal vein infiltration or portal occlusion > 2 cm	Low remant liver	Consider liver hypertrophy techniques
Right lobe atrophy associated to contralateral tumor extension more than to 2 cm from hepatic hilum
Contralateral invasion of hepatic artery	Type IV pCCC	High expertise; consider en-bloc resection
Unilobar secondary bile ducts invasion associated to contralateral infiltration or collusion of portal vein

pCCC: Perihilar cholangiocarncioma.