ARTICLE IN PRESSClinical Practice GuidelinesJOURNALOF HEPATOLOGYEASL-ILCA Clinical Practice Guidelines on the managementof intrahepatic cholangiocarcinoma*European Association for the Study of the LiverSummaryIntrahepatic cholangiocarcinoma(iCCA)develops inside the liver,between bile ductules and the second-order bile ducts.It is thesecond most frequent primary liver cancer after hepatocellular carcinoma,and its global incidence is increasing.It is associatedwith an alarming mortality rate owing to its silent presentation (often leading to late diagnosis),highly aggressive nature andresistance to treatment.Early diagnosis,molecular characterisation,accurate staging and personalised multidisciplinary treat-ments represent current challenges for researchers and physicians.Unfortunately,these challenges are beset by the high het-erogeneity of iCCA at the clinical,genomic,epigenetic and molecular levels,very often precluding successful managementNonetheless,in the last few years,progress has been made in molecular characterisation,surgical management,and targetedtherapy.Recent advances together with the awareness that iCCA represents a distinct entity amongst the CCA family,led theILCA and EASL governing boards to commission international experts to draft dedicated evidence-based guidelines for physi-cians involved in the diagnostic,prognostic,and therapeutic management of iCCA.2023 European Association for the Study of the Liver.Published by Elsevier B.V.All rights reserved.IntroductionMethodsIntrahepatic cholangiocarcinoma(iCCA)represents the second The EASL and ILCA GBs nominated (August 2020)two chairsmost frequent primary liver cancer after hepatocellular carci-and the members of the guideline expert panel,respectingnoma(HCC).The increase in incidence and mortality reportedgender balance,geographic representation and competence.worldwide (Fig.1),recent advances in our pathobiological un-Specifically,representatives from the EASL and ILCA GBs.co-derstanding,the identification of actionable molecular targets,chairs,experts of Pathology,Radiology,Clinical Oncology,and the need to clarify various aspects of clinical managementClinical Hepatology,Surgery and a methodologist joined theled the European Association for the Study of the Liver(EASL)expert panel.The Delphi panel was then established,consistingand International Liver Cancer Association (ILCA)governingof 34 physicians with gender balance,broad geographicalboards (GBs)to commission international experts to draftrepresentation and competence,and including patient repre-dedicated guidelines.Indeed,the aetiology,risk factors,sentatives (S.Lindsey,Cholangiocarcinoma Foundation;H.pathobiology,molecular biology and clinical management ofMorement,AMMF,The Cholangiocarcinoma Charity).TheiCCA are completely different with respect to perihilar CCA development of the clinical practice guidelines followed EASL's(pCCA)and distal CCA(dCCA),thus justifying guidelines spe-standard operating procedure.Objecti
