In the Bismuth-Corlette classification of hilar cholangiocarcinoma (Klatskin tumour), which type is considered unresectable on the basis of biliary involvement alone?

• A Type IV — involving second-order ducts bilaterally ✓
• B Type II — involving the common hepatic duct and bifurcation
• C Type IIIb — extending into the second-order right and left ducts
• D Type IIIa — extending into second-order right ducts only

Explanation

Bismuth-Corlette Type IV hilar cholangiocarcinoma involves the second-order biliary radicles bilaterally (both right and left hepatic ductal systems beyond the first division), making curative resection technically impossible based on biliary extent alone, as no adequate hepatic remnant with biliary continuity can be achieved. Type IIIa and IIIb extend into one side only and may be resectable with extended hemi-hepatectomy. Additional contraindications include bilateral portal vein involvement, hepatic artery encasement, or insufficient future liver remnant.

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

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