Current issues in clinical staging of perihilar cholangiocarcinoma-a European snapshot survey.

Perihilar cholangiocarcinoma (pCCA) is a rare cancer for which clinical diagnosis and staging remain challenging. To gain an understanding of the status for clinical staging in pCCA, a pan-European survey was undertaken. A multidisciplinary group from two centres (Karolinska University Hospital, Stockholm, Sweden; Amsterdam University Medical Center, Amsterdam, the Netherlands) identified issues relevant to the diagnosis and staging of pCCA. A snapshot survey was designed, targeted to clinicians across Europe. The survey covered seven areas: centralization, multidisciplinary team (MDT) review, transplantation, imaging, biliary drainage, cholangioscopy and staging laparoscopy. The electronic survey was circulated through the European Cholangiocarcinoma Network. Clinicians representing 47 hospitals from 20 European countries responded. A majority of centres (n = 33, 70%) were part of a health system with centralized pCCA care. Regardless of the type of pCCA care system, MDT review was almost uniformly available (n = 44, 94%). While more than two thirds of centres had MDT-representation of subspecialized physicians, only a minority had a nurse represented. Recommendations for primary route of biliary drainage were divided (51% endoscopic, 40% percutaneous). Availability of evaluation for transplantation differed between centralized (64%, 58% with neoadjuvant therapy) and decentralized pCCA care systems (28%, 14% with neoadjuvant therapy, P = 0.02). This pan-European survey presents a current outlook on the status of diagnostic pathways, multidisciplinary care and therapy options for patients with pCCA, reflecting both important similarities and contrasts across Europe. Recommendations for primary route of biliary drainage were divided, and access to evaluation for transplantation was associated with centralized pCCA care.