Results from the european survey on preoperative management and optimization protocols for PeriHilar cholangiocarcinoma

Francesca Ratti*, Rebecca Marino, the PeriHilar Cholangiocarcinoma Survey European Study Group, Paolo Muiesan, Krzysztof Zieniewicz, Tomas Van Gulik, Alfredo Guglielmi, Hugo P. Marques, Valdivieso Andres, Andreas Schnitzbauer, Popescu Irinel, Moritz Schmelzle, Ernesto Sparrelid, Giuseppe K. Fusai, Renè Adam, Umberto Cillo, Hauke Lang, Karl Oldhafer, Alikhanov Ruslan, Ruben CiriaAlessandro Ferrero, Vincenzo Mazzaferro, Matteo Cescon, Felice Giuliante, Silvio Nadalin, Nicolas Golse, Laurent Sulpice, Alejandro Serrablo, Emilio Ramos, Ugo Marchese, Bard Rosok, Victor Lopez-Lopez, Pierre Clavien, Luca Aldrighetti, Robert Sutcliffe

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)



Major surgery, along with preoperative cholestasis-related complications, are responsible for the increased risk of morbidity and mortality in perihilar cholangiocarcinoma (pCCA). The aim of the present survey is to provide a snapshot of current preoperative management and optimization strategies in Europe. 


61 European centers, experienced in hepato-biliary surgery completed a 59-questions survey regarding pCCA preoperative management. Centers were stratified according to surgical caseload (<5 and ≥ 5 cases/year) and preoperative management protocols’ application. 


The overall case volume consisted of 6333 patients. Multidisciplinary discussion was routinely performed in 91.8% of centers. Most respondents (96.7%) recognized the importance of a well-structured preoperative protocol. The preferred method for biliary drainage was percutaneous transhepatic biliary drainage (60.7%) while portal vein embolization was the preferred technique for liver hypertrophy (90.2%). Differences in preoperative pathologic confirmation of malignancy (35.8% vs 28.7%; p < 0.001), number of mismanaged referred patients (88.2% vs 50.8%; p < 0.001), biliary drainage (65.1% vs 55.6%; p = 0.015) and liver function evaluation (37.2% vs 5.6%; p = 0.001) were found between centers according to groups’ stratification. 


The importance of a correct preoperative management is recognized. Nevertheless, the current lack of guidelines leads to wide heterogeneity of behaviors among centers. This survey can provide recommendations to improve pCCA perioperative outcomes.

Original languageEnglish
Pages (from-to)1302-1322
Number of pages21
Issue number11
Publication statusPublished - Nov 2023

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© 2023 International Hepato-Pancreato-Biliary Association Inc.


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