Hepatocellular cholangiocarcinoma (HCCA) is one of the most common hepatobiliary cancers reported worldwide, including the Asia-Pacific region. HCCA can be completely asymptomatic in its early stages. When significant hilar obstruction is present, patients may develop jaundice, grayish stools, dark urine, itchy skin, abdominal pain, and sometimes fever. Since there is no single test for a definitive diagnosis, we need a comprehensive evaluation using multiple methods such as tumor markers, tissue biopsy, computed tomography, magnetic resonance imaging/magnetic resonance endoscopic ultrasound of the pancreatic bile ducts/intracavitary ultrasound, and advanced cholangioscopy. Surgery is the only curative method. Unfortunately, most HCCAs have a poor prognosis due to being in an advanced state of cancer at the time of presentation. Although there is no survival advantage, palliative drainage for patients with inoperable HCCA is beneficial for symptomatic improvement. Currently, there are three techniques to achieve biliary drainage, including transendoscopic, percutaneous, and transoperative. For non-surgical treatment methods, implantation of stents is the best option, and two types of stents are available, namely plastic stents and metal stents. The type and number of HCCA biliary drainage stents are still controversial and need to be decided by a combination of several aspects, i.e., liver drainage volume, life expectancy, and experience of the medical institution. Recently, radiofrequency ablation and photodynamic therapy are promising techniques to expand the scope of drainage openings. Given a summary of the literature and regional data, the Hepatobiliary Cancer Asia Pacific Working Group has issued recommendations to assist clinicians for the diagnosis and treatment of HCCA.