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=== '''Resectability''' === ** '''Unresectable factors''' (based on Blumgart staging system): *** Patient factors **** Medically unfit for major operation **** Cirrhosis *** Local tumour-related factors (Blumgart T2 or T3) **** Hepatic duct involvement up to secondary biliary radicals bilaterally (that is, proximal to both right and left CHD) **** Encasement or occlusion of the main portal vein proximal to its bifurcation **** Atrophy of one hepatic lobe with contralateral encasement of portal vein branch **** Atrophy of one hepatic lobe with contralateral involvement of secondary biliary radicals **** Unilateral tumour extension to secondary biliary radicles with contralateral vein branch encasement or occlusion *** Metastatic disease **** Histologically proven metastases to distant lymph node basins **** Lung, liver or peritoneal mets
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