Nationwide analysis on the impact of the organization of care on the outcomes of perihilar cholangiocarcinoma

: Perihilar cholangiocarcinoma (pCCA) is a rare and complex liver malignancy requiring specialized care in academic centers and multidisciplinary teams (MDTs). This study aimed to evaluate the impact of academic centers, academic MDTs, and regional collaboration on treatment outcomes. : Patients with pCCA between 2017 and 2021 were identified from the Dutch Cancer Registry. The impact of center of initial diagnosis, including academic and non-academic center, and the involvement of academic MDTs were analyzed. Outcomes included tumor-directed therapy and overall survival (OS). : In total, 1365 patients were included; 155 (11.4%) initially presented in an academic centers. Initial biliary drainage in academic centers was associated with lower 90-day mortality (25.0% and 40.5%, P<0.001) compared with non-academic centers. Initial diagnosis in an academic center was associated with higher rates of tumor-directed therapy (63.5% vs 32.0%, P<0.001) and surgery (36.1% vs 14.7%, P<0.001). Expert MDT evaluation, regardless of center of diagnosis, showed higher rates of tumor-directed therapy (45.5% vs 9.9%, P<0.001) and surgery (23.8% vs 2.5%, P<0.001). Additionally, academic MDTs were independently associated with improved OS (HR 0.55 95% CI 0.48-0.63, P<0.001) in multivariable analysis. : Patients with pCCA discussed in academic MDTs had higher rates of tumor-directed therapy and improved OS. This association may partly be explained by patient selection and referral patterns. Nevertheless, these findings emphasize the importance of regional collaboration and centralization of care to ensure that all patients benefit from specialized expertise and coordinated treatment planning.