Table 2.
Criteria for unresectability[15]
| Patient factors |
| Medically unfit or otherwise unable to tolerate a major operation |
| Hepatic cirrhosis |
| Local tumor-related factors |
| Tumor extension to secondary biliary radicles bilaterally |
| Encasement or occlusion of the main portal vein proximal to its bifurcation |
| Atrophy of one hepatic lobe with contralateral portal vein branch encasement or occlusion |
| Atrophy of one hepatic lobe with contralateral tumor extension to secondary biliary radicles |
| Unilateral tumor extension to secondary biliary radicles with contralateral portal vein branch |
| encasement or occlusion |
| Metastatic disease |
| Histologically proven metastases to N2 lymph nodes1 |
| Lung, liver, or peritoneal metastases |
1
Metastatic disease to peripancreatic, periduodenal, celiac, superior mesenteric, or posterior pancreaticoduodenal lymph nodes was considered to represent disease not amenable to a potentially curative resection. By contrast, metastatic disease to cystic duct, pericholedochal, hilar, or portal lymph nodes (i.e., within the hepatoduodenal ligament) did not necessarily constitute unresectability.