This study introduces the ABC scoring system for preoperative staging in perihilar cholangiocarcinoma, aiming to improve patient selection for curative surgery.

• Patients with a score of 3 had a 21% 90-day mortality rate versus 6% for score 0.
• Six-month recurrence rates were 18% for score 3 compared to 5% for score 0.
• Median overall survival was 13 months for score 3 versus 39 months for score 0.

Surgeons should carefully consider the ABC score, especially for high-risk patients, to potentially avoid unnecessary surgery and improve outcomes.