A recent study has shown that the main factors affecting the management of hilar cholangiocarcinoma are the degree of diagnostic certainty, the general condition of the patient, the functional reserve of the liver, and the staging of the disease. In patients with obstructive jaundice, the Child-Pugh score is not an accurate assessment of hepatic reserve function, and 3D assessment is often needed to confirm it. It has been suggested that preoperative 3D assessment can change the design of 33% of complex hepatic resections IIIo optimize the surgical procedure and improve patient prognosis. Although the diagnosis and treatment of hepatoportal cholangiocarcinoma have made great progress in recent decades, the postoperative mortality rate of patients is still reported to be high. Among the most common postoperative complications are bleeding, liver failure, bile leakage, biliary bleeding, and infectious complications. With the development of imaging technology and the transformation of surgical methods, the diagnosis and treatment of hepatoportal cholangiocarcinoma have made great progress. Although its resection rate is not very high, a positive attitude towards surgical resection should still be taken because it provides the only possible chance to cure the disease. Currently, the surgical approach for hilar cholangiocarcinoma mainly depends on Bismuth staging, and whether to achieve radical (R0) resection is still the most important factor in determining whether the patient can survive for a long time. Radical resection: Hepatoportal cholangiocarcinoma has strong local infiltration ability and is easy to invade bile ducts, hepatic arteries and portal veins, and is also easy to metastasize along nerve fibers and lymphatic vessels; even in patients with T1 stage, nearly 1/3 of them will have nerve fiber invasion phenomenon. Therefore, some scholars believe that simple extrahepatic choledochotomy should be avoided because it increases the possibility of R1 and R2 resection, does not help lymph node clearance, and seriously affects the survival of patients. It is generally believed that radical resection should include extrahepatic bile duct resection, “skeletonization” of blood vessels in the hepatoduodenal ligament, extensive resection of fibro-adipose tissues, nerves and lymph on the duodenal ligament, resection of one side of the hepatic lobe if necessary, and choledocho-jejunal anastomosis. Early lymph node and nerve infiltration in patients with hepatoportal cholangiocarcinoma will seriously affect the survival rate of patients. Progressive hepatoportal cholangiocarcinoma often has infiltration of the caudate lobe, so when the tumor invades the confluence or the left or right hepatic ducts, the caudate lobe should be combined with resection of the caudate lobe. Because the caudate lobe is considered to be a common site of tumor recurrence, it is one of the main correlates affecting the long-term survival of patients. A recent study of 127 patients showed that the overall survival of patients with combined caudate lobectomy was 64 months, while that of patients without caudate lobectomy was 34.7 months. 2, extended radical surgery: extended radical surgery usually refers to the need to combine with partial hepatectomy or pancreaticoduodenectomy. In recent years, combined hepatic resection has been widely used, and it is reported that the radical resection rate can reach 60%~80%. Combined left- and right-triple-lobe resections have higher negative margin rates than extended hemihepatectomy, but at the same time increase the risk of postoperative liver failure and small liver syndrome. It has been demonstrated that the incidence of postoperative small liver syndrome in patients undergoing extensive hepatectomy can reach 1% to 5%, and often leads to liver failure or even patient death. Conventional prophylactic measures include preoperative biliary drainage and portal vein embolization, but ALPPS, a staged hepatectomy combining hepatic parenchymal dissection and portal vein ligation, has emerged in recent years as a promising new option.Vennarecci et al. have shown that ALPPS can be considered to increase the chance of radical resection and reduce the incidence of postoperative liver failure and small liver syndrome in patients with portal vein branch invasion that precludes successful performance of the classic two-step approach, in patients who are expected to have insufficient residual liver volume at 6-9 weeks after portal vein embolization, or in patients who are likely to experience rapid tumor progression while waiting for the traditional approach. Pancreaticoduodenectomy should be performed when the tumor invades from the hepatic duct to the pancreatic segmental duct or even the end of the common hepatic duct, or metastasizes along the bile duct and the posterior lymph nodes of the pancreatic head. However, some scholars believe that it should be avoided due to the complications and high mortality rate of surgery. 3.Combined resection and reconstruction of blood vessels: Studies have shown that the portal vein of patients with hepatoportal cholangiocarcinoma is very easy to be invaded and seriously affects the survival rate of patients, so some scholars believe that combined resection and reconstruction of the portal vein can significantly improve the prognosis of the patients and increase the radical resection rate. A recent meta-analysis showed that combined portal vein resection resulted in a higher mortality rate and a statistically insignificant difference in five-year survival compared with the control group, and caused some secondary diseases. However, DeJong et al. and Hemming et al. concluded that portal vein resection is significant in improving the survival of patients with progressive hilar cholangiocarcinoma and should not be a contraindication to surgical resection.A retrospective study conducted by Neuhaus et al. showed that the five-year survival of patients who underwent a nonintrusive technique of portal vein resection was 58%, compared with 29% of those who had a conventional procedure. The five-year survival rate was 29%, so intraoperative touching of the tumor and causing metastasis should be avoided as much as possible. The resection and reconstruction of the involved hepatic artery is controversial, but most scholars are in favor of it. Recently, Liang Yurong et al. retrospectively analyzed the hepatic portal cholangiocarcinoma involving hepatic artery involvement, and for the first time, gastroduodenal artery bypass grafting was used to reconstruct hepatic arteries ≥2 cm in length, which achieved more satisfactory results.