A 65-year-old jaundiced patient has a hilar cholangiocarcinoma on MRCP. The Bismuth-Corlette classification is used for surgical planning. Which type is associated with the worst resectability and requires the most extensive surgery?

• A Type I: involves common hepatic duct below confluence
• B Type II: involves confluence without involvement of right or left hepatic ducts
• C Type IIIa/IIIb: involves confluence and right or left hepatic duct up to secondary radicles
• D Type IV: involves both right and left hepatic duct radicles bilaterally ✓

Explanation

Bismuth-Corlette Type IV hilar cholangiocarcinoma involves both the right and left hepatic ducts bilaterally up to secondary radicles and is essentially unresectable in most cases. Type IIIa (right duct involvement) requires right hepatectomy and caudate lobe resection; Type IIIb (left duct) requires left hepatectomy. Type I and II are more amenable to resection with bile duct excision and reconstruction. Pre-operative portal vein embolisation of the planned resected lobe is often needed to hypertrophy the future liver remnant.

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

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Written and medically reviewed by the StethoPrep medical team.