The Bismuth-Corlette classification of hilar cholangiocarcinoma is critical for surgical planning. Which type requires contralateral hepatectomy along with biliary reconstruction due to involvement of the secondary biliary radicles bilaterally?
- A Type I
- B Type II
- C Type IIIa or IIIb ✓
- D Type IV
Correct answer: C. Type IIIa or IIIb
Explanation
Bismuth-Corlette Type IIIa involves the right second-order biliary radicles in addition to the confluence, requiring left hepatectomy to achieve clear margins; Type IIIb involves the left secondary radicles, requiring right hepatectomy. Both necessitate major hepatectomy with en-bloc bile duct excision. Type I is confined to the common hepatic duct; Type II involves the confluence; Type IV involves bilateral secondary radicles and is generally unresectable. Correct surgical planning depends on pre-operative biliary mapping (MRCP and CT volumetry).
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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