Abstract: Hilar cholangiocarcinoma is a highly intractable malignancy, and most patients with this disease were diagnosed as a locally advanced stage at their initial presentation. Surgical resection remains as the only curative treatment for hilar cholangiocarcinoma. Hepatic surgeons focus on how to perform radical resection safely and effectively. For locally advanced hilar cholangio-carcinoma, aggressive surgical approach substantially increases the resectability of tumors which were initially regarded as unresectable. Hemihepatectomy or trisectionectomy combined with caudate lobectomy is the standard operation for radical resection of hilar cholangiocarcinoma, vascular resection and lymphadenectomy can be performed selectively. The safety and success of surgical approach is guaranteed by meticulous preoperative management such as preoperative biliary drainage and portal vein embolization, which prevent fatal postoperative complications. Multidisciplinary approach is required for the treatment of hilar cholangiocarcinoma. The combina-tion of aggressive surgical approach and adjuvant therapy remain a promising approach for further improving the resectability of tumors and the survival of patients.