Surgery · Hepatobiliary Surgery (Liver Tumors, Gall Bladder, Bile Duct, Pancreas)

Bismuth-Corlette classification of Klatskin tumors: which type is NOT resectable with curative intent using standard hepatic resection alone?

  • A Type I
  • B Type IV
  • C Type II
  • D Type IIIa
Correct answer: B. Type IV

Explanation

Bismuth-Corlette Type IV hilar cholangiocarcinoma involves the second-order biliary radicles of both right and left hepatic ducts, making curative-intent resection with negative margins essentially impossible with standard surgery. Types I–III can be addressed with bile duct resection ± hepatectomy: Type I (common hepatic duct, below confluence), Type II (confluence), Type IIIa (right hepatic duct to second order), Type IIIb (left side). Type IV bilateral second-order involvement requires either liver transplantation (Mayo protocol for highly selected patients) or palliative drainage.

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

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