Classifying extrahepatic bile duct metachronous carcinoma by de novo neoplasia site

Figure 4 Classification of metachronous bile duct carcinoma according to the site of de novo neoplasia. Type 1 tumors occur at the proximal and/or distal remnant bile ducts. Type 1a tumors with involvement of the proximal remnant bile duct only require hepatectomy. Type 1b tumors with involvement of the distal remnant bile duct only require pancreaticoduodenectomy. Type 1c tumors with involvement of both proximal and distal remnant bile ducts require hepatectomy and pancreaticoduodenectomy. Type 2 tumors with involvement of the proximal remnant bile duct after pancreatoduodenectomy require hepatectomy.