Perihilar cholangiocarcinoma (pCCA) arising at the hepatic duct confluence presents a demanding clinical problem when anatomical or oncological factors preclude upfront resection. In a carefully defined subset of patients, early localised disease may still be approached with curative intent through a structured multi-step strategy.
Early-stage unresectable perihilar cholangiocarcinoma: tumour stage T1–T2, perihilar mass less than 3 cm in radial diameter, no regional lymph node metastasis (N0), no distant metastasis (M0).
For patients meeting these strict staging criteria, evidence supports a neoadjuvant approach as a preparatory phase before a definitive surgical procedure. The full protocol — including the complete treatment sequence, eligibility requirements, and patient selection criteria — is in the structured regimen below.
Neoadjuvant chemoradiotherapy followed by LT can be considered for selected patients with early-stage (T1-2 which are less than 3 cm, N0, M0) unresectable pCCA (LoE 3, weak recommendation, strong consensus).
DOI: 10.1016/j.jhep.2025.03.007