A 55-year-old patient with primary sclerosing cholangitis (PSC) develops a dominant stricture of the proximal bile duct. MRI/MRCP shows a 3 cm hilar mass. Staging reveals no distant metastasis. The lesion is classified as Bismuth-Corlette type IIIa. What defines this classification?
- A Involvement up to the confluence, with extension into the right hepatic duct ✓
- B Involvement of common hepatic duct only
- C Multifocal involvement of both right and left intrahepatic ducts
- D Involvement of both right and left hepatic ducts plus right posterior sectoral duct
Explanation
The Bismuth-Corlette classification grades hilar cholangiocarcinoma (Klatskin tumor) by extent of ductal involvement: Type I involves common hepatic duct below confluence; Type II involves the confluence; Type IIIa extends into the right hepatic duct; Type IIIb extends into the left hepatic duct; Type IV involves both right and left hepatic ducts (and/or multifocal). Type IIIa requires right hepatectomy with caudate lobe resection for curative resection. Knowing the type determines resectability and the required hepatic resection. PSC patients with cholangiocarcinoma may be candidates for liver transplantation at specialized centers per Mayo protocol.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.