A 65-year-old patient with hilar cholangiocarcinoma (Klatskin tumor) is staged as Bismuth-Corlette type IIIa. This implies the tumor involves:

• A Common hepatic duct with extension into bilateral second-order ducts
• B Common hepatic duct only, sparing the confluence
• C Confluence with bilateral extension into second-order ducts
• D Confluence with unilateral extension into right second-order bile ducts ✓

Explanation

The Bismuth-Corlette classification of hilar cholangiocarcinoma: Type I involves common hepatic duct below confluence; Type II involves the confluence; Type IIIa involves the confluence with extension into right second-order bile ducts (right hepatic duct and branches); Type IIIb involves confluence with extension into left second-order ducts; Type IV involves bilateral second-order duct involvement. Type IIIa requires right hepatectomy with caudate lobe (segment 1) resection for R0 resection, as the caudate drains directly into the hepatic duct confluence. Preoperative portal vein embolization may be needed if future liver remnant is inadequate.

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

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Written and medically reviewed by the StethoPrep medical team.