A 60-year-old jaundiced man is found to have a Klatskin tumour (hilar cholangiocarcinoma) on MRCP. The tumour involves the right and left hepatic ducts up to their secondary radicles with right portal vein involvement. What is the Bismuth-Corlette classification?

• A Type II
• B Type IIIa
• C Type IIIb
• D Type IV ✓

Explanation

The Bismuth-Corlette classification of hilar cholangiocarcinoma: Type I = below confluence; Type II = at confluence; Type IIIa = extends to right secondary radicles; Type IIIb = extends to left secondary radicles; Type IV = involves secondary radicles bilaterally. Involvement of both right and left hepatic ducts to their secondary radicles defines Type IV, which is generally considered unresectable. Portal vein involvement also worsens prognosis but the anatomical duct involvement alone places this as Type IV.

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

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