# Bismuth-Corlette — Modified Bismuth-Corlette classification of perihilar cholangiocarcinoma

> Five-type map of longitudinal tumor extension through the primary and right/left secondary biliary confluences. It does not encode vascular invasion, lobar atrophy, nodal or distant disease, future liver remnant, resectability or prognosis and cannot prescribe a resection or drainage route by itself.

**Situação:** vigente · **Órgão:** Vias biliares · **Órgão emissor:** Bismuth and Corlette / hepatobiliary surgery · **Versão:** 1975 framework; 1992 modification; 2025 EASL staging boundary · **Ano:** 1975

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: MRI, CT
- Fonte primária: Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver (1975) — https://pubmed.ncbi.nlm.nih.gov/1079096/
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Use modified Bismuth-Corlette only for the longitudinal duct map. Always expose confluences, vessels, atrophy, metastases and future liver remnant separately; no type automatically determines resection, drainage, transplant or prognosis.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| I | Type I | Tumor extends within the common hepatic duct but remains below the primary right-left hepatic-duct confluence; the primary confluence and both right and left secondary ductal confluences are spared. Confirm the map on preintervention MRI/MRCP when possible and state actual ductal variants. | Treat type I as a longitudinal duct descriptor, not an instruction for bile-duct-only resection, right hepatectomy or ERCP. A specialist hepatobiliary multidisciplinary team determines R0 resection feasibility from the inferior margin, vessels, lobar atrophy, nodes, metastases, future liver remnant, fitness and anatomy. Avoid routine preoperative drainage; when a separate indication exists, route and target are individualized. | Type I has the least proximal ductal extent in this framework but no validated independent survival or resectability probability. Margin feasibility, tumor biology, nodal or distant disease, vascular involvement, future liver remnant and patient fitness dominate prognosis; do not describe type I as low-risk cancer solely from the numeral. | Bismuth and Corlette 1975, PMID 1079096, original lineage; Bismuth et al. 1992, PMC1242367, modified surgical framework; EASL CPG 2025, DOI 10.1016/j.jhep.2025.03.007, pCCA radiology, staging, resectability, surgery and biliary-drainage sections. | ✓ |
| II | Type II | Tumor involves the primary right-left hepatic-duct confluence but spares both the right and left secondary ductal confluences. Mere contact near the hilum is insufficient: report whether the primary confluence is truly infiltrated and whether both secondary confluences remain assessable and free. | Map both secondary confluences, hepatic artery and portal vein, lobar atrophy, future liver remnant and metastases before deciding resectability or resection extent. Type II does not universally select a right-sided operation or endoscopic drainage. If preoperative drainage is clinically required, target the intended future liver remnant and select endoscopic or percutaneous access from anatomy and expertise rather than type alone. | Type II implies primary-confluence involvement and greater ductal complexity than type I, but the classification has no type-II-specific calibrated prognosis. An anatomically resectable type II with favorable margins and nodes may have a different outlook from a metastatic type I; formal AJCC stage and multidisciplinary resectability variables must remain separate. | Bismuth-Corlette five-type anatomy as retained in EASL 2025 and Dar et al. 2024 PMC10989497; EASL diagnosis/staging and surgical sections for MRI/MRCP, multiphasic CT, AJCC and non-Bismuth resectability fields; drainage section for indication- and anatomy-led access. | ✓ |
| IIIa | Type IIIa | Tumor involves the primary confluence and extends into the RIGHT secondary ductal confluence, while the left secondary confluence remains spared. Map right anterior and posterior sectoral ducts and variants; vague extension into a proximal right duct is not enough when the secondary confluence cannot be assessed. | A right-sided or extended resection may be considered, but IIIa never automatically means right trisectionectomy. The operative plan depends on actual sectoral anatomy, arterial and portal involvement, ipsilateral or contralateral atrophy, achievable margins and the volume, function and drainage of the future liver remnant. Drainage is not routine and its route cannot be selected from IIIa alone. | Unilateral secondary-confluence involvement increases reconstruction and margin complexity but supplies no independent IIIa survival percentage. Resectability and outcome depend on contralateral duct preservation, vessels, lobar atrophy, future liver remnant, nodes, metastases, biology and center expertise rather than the suffix a. | Modified Bismuth-Corlette anatomy in Bismuth et al. 1992, PMC1242367, and current EASL 2025 pCCA sections; Dar et al. 2024, PMC10989497, Bismuth classification, preoperative imaging and surgical-resection factors for type III planning. | ✓ |
| IIIb | Type IIIb | Tumor involves the primary confluence and extends into the LEFT secondary ductal confluence, while the right secondary confluence remains spared. Map the left sectoral ducts and any right-sided variant draining into the left system before assigning the side-specific suffix. | A left-sided or extended resection may be considered, but IIIb never automatically means left trisectionectomy. Determine the side and extent from ductal variants, vascular involvement, lobar atrophy, margins and future liver remnant. If biliary drainage has an independent indication, drain viable intended remnant liver and choose the route through multidisciplinary expertise, not the IIIb token. | Type IIIb indicates unilateral left secondary-confluence extension but is not a prognostic stage or a calibrated operative-risk group. Individual outcome is driven by R0 feasibility, vascular and metastatic disease, nodes, future liver remnant, physiology and treatment pathway. Avoid claiming that IIIa and IIIb have an intrinsic ordinal risk difference. | Bismuth et al. 1992 modified framework; EASL 2025 MRI/MRCP anatomy, CT vascular/metastatic staging, resectability and drainage guidance; Dar et al. 2024 surgical-planning discussion including biliary extent, atrophy, vascular involvement, dominance and variants. | ✓ |
| IV | Type IV | Tumor involves BOTH right and left secondary ductal confluences; modified formulations also include multifocal or discontinuous bilateral ductal disease. Name the exact bilateral confluences or skip lesions and distinguish true tumor from stent-related inflammation or inadequate post-drainage visualization. | Type IV is not automatically unresectable. Expert multidisciplinary assessment may identify selected candidates for complex R0 resection or a protocolized transplant pathway, while metastatic, vascular, remnant-liver or physiologic factors may preclude either. Do not assign trisectionectomy, transplantation or combined endoscopic/percutaneous drainage from the label; each requires its own anatomic and clinical eligibility gate. | Type IV denotes the broadest ductal extent and often high technical complexity, but modern expert centers have resected selected type-IV tumors and the code does not yield an individual survival probability. Prognosis depends on margins, nodes, metastases, vascular involvement, remnant liver, biology, treatment eligibility and response; transplant-series survival must not be attributed to all type-IV patients. | Modified Bismuth-Corlette bilateral/multifocal definition; EASL 2025 evidence review noting resection across Bismuth types and superiority of broader staging for resectability/survival; EASL surgery, transplant and drainage sections; Dar et al. 2024, selected type-IV surgical boundary. | ✓ |

### Citações por categoria
- **I**: Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver (1975) — https://pubmed.ncbi.nlm.nih.gov/1079096/ · Bismuth and Corlette 1975, PMID 1079096, original lineage; Bismuth et al. 1992, PMC1242367, modified surgical framework; EASL CPG 2025, DOI 10.1016/j.jhep.2025.03.007, pCCA radiology, staging, resectability, surgery and biliary-drainage sections.
- **II**: Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver (1975) — https://pubmed.ncbi.nlm.nih.gov/1079096/ · Bismuth-Corlette five-type anatomy as retained in EASL 2025 and Dar et al. 2024 PMC10989497; EASL diagnosis/staging and surgical sections for MRI/MRCP, multiphasic CT, AJCC and non-Bismuth resectability fields; drainage section for indication- and anatomy-led access.
- **IIIa**: Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver (1975) — https://pubmed.ncbi.nlm.nih.gov/1079096/ · Modified Bismuth-Corlette anatomy in Bismuth et al. 1992, PMC1242367, and current EASL 2025 pCCA sections; Dar et al. 2024, PMC10989497, Bismuth classification, preoperative imaging and surgical-resection factors for type III planning.
- **IIIb**: Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver (1975) — https://pubmed.ncbi.nlm.nih.gov/1079096/ · Bismuth et al. 1992 modified framework; EASL 2025 MRI/MRCP anatomy, CT vascular/metastatic staging, resectability and drainage guidance; Dar et al. 2024 surgical-planning discussion including biliary extent, atrophy, vascular involvement, dominance and variants.
- **IV**: Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver (1975) — https://pubmed.ncbi.nlm.nih.gov/1079096/ · Modified Bismuth-Corlette bilateral/multifocal definition; EASL 2025 evidence review noting resection across Bismuth types and superiority of broader staging for resectability/survival; EASL surgery, transplant and drainage sections; Dar et al. 2024, selected type-IV surgical boundary.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-07-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2025-05-01 | revised | The EASL extrahepatic-cholangiocarcinoma guideline retained Bismuth as a longitudinal ductal descriptor while defining modern cross-sectional staging, resectability and drainage boundaries; it did not create a new Bismuth type set. | confirmed |
| 1992-01-01 | revised | Bismuth, Nakache and Diamond published the modified surgical-strategy framework underlying the current five-type Bismuth-Corlette map. | confirmed |
| 1975-02-01 | published | Bismuth and Corlette introduced a ductal-extent framework for carcinoma of the hepatic hilum. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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