In the Bismuth-Corlette classification of hilar cholangiocarcinoma (Klatskin tumor), a type IIIb lesion extends into which specific ductal system?

• A Common hepatic duct and right hepatic duct second-order branches
• B Common hepatic duct involvement only below the confluence
• C Both right and left hepatic ducts extending to second-order branches bilaterally
• D Common hepatic duct, confluence, and left hepatic duct second-order branches (segment II/III) ✓

Explanation

In the Bismuth-Corlette classification: Type I involves common hepatic duct below the confluence; Type II involves the confluence without extension into hepatic ducts; Type IIIa extends into right hepatic duct second-order branches; Type IIIb extends into left hepatic duct second-order branches (involving segments II and III); Type IV extends into both second-order branches bilaterally and is deemed unresectable. For type IIIb, a right hepatectomy (segments V-VIII) plus caudate lobe resection is typically required (as the caudate drains directly into the hepatic duct confluence). Extended left hepatectomy is required for type IIIa. The caudate lobe (segment I) is always removed in curative resection because its ducts directly drain into the confluence.

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

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Written and medically reviewed by the StethoPrep medical team.