New staging system and a registry for perihilar cholangiocarcinoma§


  • Potential conflict of interest: Nothing to report.

  • This study was supported by the Liver and Gastrointestinal Foundation (Zurich, Switzerland). Michelle L. DeOliveira was supported by the Brazilian Ministry of Education through Coordenadoria de Aperfeicoamento de Pessoal de Nivel Superior (grant BEX1429-08) and was the recipient of a University of Zurich clinical assistant professorship supported by the Waring Foundation.

  • §

    After the expert opinion conference organized by the European Hepato-Biliary Association (Brussels, Belgium, November 2007), the authors created an international cholangiocarcinoma working group to design a new staging system and a registry.


Perihilar cholangiocarcinoma is one of the most challenging diseases with poor overall survival. The major problem for anyone trying to convincingly compare studies among centers or over time is the lack of a reliable staging system. The most commonly used system is the Bismuth-Corlette classification of bile duct involvement, which, however, does not include crucial information such as vascular encasement and distant metastases. Other systems are rarely used because they do not provide several key pieces of information guiding therapy. Therefore, we have designed a new system reporting the size of the tumor, the extent of the disease in the biliary system, the involvement of the hepatic artery and portal vein, the involvement of lymph nodes, distant metastases, and the volume of the putative remnant liver after resection. The aim of this system is the standardization of the reporting of perihilar cholangiocarcinoma so that relevant information regarding resectability, indications for liver transplantation, and prognosis can be provided. With this tool, we have created a new registry enabling every center to prospectively enter data on their patients with hilar cholangiocarcinoma ( The availability of such standardized and multicenter data will enable us to identify the critical criteria guiding therapy. (HEPATOLOGY 2011;)