National consensus on a new resectability classification for perihilar cholangiocarcinoma - A modified Delphi method
European Journal of Surgical Oncology, vol. 51, pp. 107117
Abstract
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.
Authors 18
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Cancer Center Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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University Medical Center Groningen
Affiliation as printed
University Medical Center Groningen, Department of Surgery, Groningen, the Netherlands
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Leiden University Medical Center
Affiliation as printed
LUMC, Department of Surgery, Leiden, the Netherlands
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Maastricht University Medical Centre
Affiliation as printed
Maastricht UMC, Department of Surgery, Maastricht, the Netherlands
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Maastricht University Medical Centre
Affiliation as printed
Maastricht UMC, Department of Surgery, Maastricht, the Netherlands
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University Medical Center Utrecht
Affiliation as printed
UMCU, Department of Surgery, Utrecht, the Netherlands
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University Medical Center Groningen
Affiliation as printed
University Medical Center Groningen, Department of Surgery, Groningen, the Netherlands
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Leiden University Medical Center
Affiliation as printed
LUMC, Department of Surgery, Leiden, the Netherlands
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University Medical Center Utrecht
Affiliation as printed
UMCU, Department of Surgery, Utrecht, the Netherlands
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Maastricht University Medical Centre
Affiliation as printed
Maastricht UMC, Department of Surgery, Maastricht, the Netherlands
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University Medical Center Groningen
Affiliation as printed
University Medical Center Groningen, Department of Surgery, Groningen, the Netherlands
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Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC, Location Universiteit van Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Amsterdam UMC, Location Universiteit van Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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Cancer Center Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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Cancer Center Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam
Affiliation as printed
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC, Location Universiteit van Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands
Amsterdam UMC, Location Universiteit van Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam
Affiliation as printed
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC, Location Universiteit van Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Amsterdam UMC, Location Universiteit van Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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Affiliation as printed
Erasmus MC Cancer Institute, Department of Surgery, Rotterdam, the Netherlands
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Joris I. Erdmann corresponding
Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC, Location Universiteit van Amsterdam, Department of Surgery, Amsterdam, the Netherlands. Electronic address: j.i.erdmann@amsterdamumc.nl
Amsterdam UMC, Location Universiteit van Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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