There are various staging systems proposed for hilar cholangiocarcinoma and at present the choice of the best system is still under debate.

As noted previously, the classifications listed show different features and can be divided into two categories: clinical and pathological staging systems.

The clinical classifications [1,11,14] serve to define criteria of resectability, indicate the type of operation and estimate the prognosis of the disease.

Bismuth-Corlette classification divides patients only based on extent of biliary involvement and does not consider other important elements of the preoper-ative evaluation such as vascular involvement and lobar atrophy; therefore it cannot be used to assess resectability [1,2].

The Gazzaniga classification proposed in 1985 has added the degree of vascular involvement [11] to evaluation of extent of biliary involvement; however its diffusion in clinical practice is very limited.

The clinical classification proposed by MSKCC adds vascular involvement and hepatic atrophy evaluation of extent of biliary involvement according to the Bismuth-Corlette classification [13,14].

TNM UICC/AJCC [4] and JSBS [10] staging systems are based on histopathologic criteria and evaluate the local and distant extent after surgical operation. These classifications have mainly prognostic significance but are not useful for assessing resectability. The complexity of JSBS classification limits its use in clinical practice.

A classification of this disease that permits a complete evaluation of resectability and outcome is not available at present. It would be useful to have a staging system that combine biliary involvement, vascular invasion, local extent and lymph-node involvement.

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