In Klatskin tumor (hilar cholangiocarcinoma), the Bismuth-Corlette classification type IIIb indicates involvement up to which level?

• A Confluence with extension into the left secondary hepatic ducts ✓
• B Common hepatic duct extending to the confluence
• C Confluence with extension into the right secondary hepatic ducts
• D Involvement of both right and left secondary hepatic ducts

Explanation

The Bismuth-Corlette classification categorizes hilar cholangiocarcinoma: Type I—below confluence; Type II—at confluence; Type IIIa—right hepatic duct extending to right secondary radicles; Type IIIb—left hepatic duct extending to left secondary radicles; Type IV—involves both right and left secondary radicles (multifocal). Type IIIb tumors typically require right trisectionectomy (extended right hepatectomy) sparing the left lobe, whereas type IIIa requires left hepatectomy or trisectionectomy. This classification guides surgical planning including hepatic resection extent.

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

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