A 60-year-old man with biliary stricture and progressive jaundice is found to have a perihilar cholangiocarcinoma (Klatskin tumor). MRI shows involvement of the right hepatic duct up to the secondary radicles and left hepatic duct, with compression of the right portal vein. This corresponds to which Bismuth-Corlette classification?

• A Type II
• B Type IIIb
• C Type IV
• D Type IIIa ✓

Explanation

The Bismuth-Corlette classification of hilar cholangiocarcinoma: Type I—common hepatic duct only; Type II—confluence involved; Type IIIa—right secondary radicles involved; Type IIIb—left secondary radicles involved; Type IV—bilateral secondary radicles. This case shows right secondary radicle involvement (up to right secondary radicles) plus right portal vein compression, consistent with Type IIIa. Type IIIa typically requires right hepatectomy plus caudate lobe resection for curative resection.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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