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Purpose: To determine the presence and extent of preoperative biliary obstructions, using magnetic resonance cholangiopancreatography (MRCP), and to determine the clinicopathological consequences of these obstructions in a group of 83 patients with hilar cholangiocarcinoma (HC).Methods: Fifty-five HC patients with biliary obstruction and 28 HC patients without biliary obstruction were included in the study. The associations between biliary obstruction (assessed using MRCP) and clinicopathological characteristics were analysed.Results: Patients with biliary obstruction had a higher liver function and serum carbohydrate antigen than those without biliary obstruction. The Bismuth-Corlette classification, tumour stage and lymph node metastasis were identified as independent relative factors of biliary obstruction, while differentiation and biliary obstruction were identified as independent factors of overall survival. Furthermore, the size of the tumour, differentiation and biliary obstruction were independent prognostic indicators of disease-free survival for HC patients.Conclusions: The presence and extent of preoperative biliary obstruction, measured by MRCP, was associated with aggressive clinicopathological features and indicated poor prognosis in HC patients. [ABSTRACT FROM AUTHOR]