Objective  To compare the relationship between the operative strategies and clinical outcomes of type Ⅲ and Ⅳ hilar cholangiocarcinomas (HCs).

  Methods  We retrospectively analyzed the clinical data and long-term outcomes for 50 cases of type Ⅲ and Ⅳ HC that underwent surgery at the Tianjin Medical University Cancer Hospital.

  Results  Fifty patients were followed up and the median follow-up duration was 27 months. The hilar limited hepatectomy group included 13 cases; the median disease-free survival was 6 months, and 1-and 2-year disease-free survival rates were 30.8% and 23.1%, respectively. The median overall survival was 20 months, and the 1-and 2-year overall survival rates were 76.9% and 38.5%, respectively. The extended hepatectomy group included 37 cases; the median disease-free survival was 14 months, and 1-and 2-year disease-free survival rates were 59.5% and 32.4%, respectively. The median overall survival was 37 months, and the 1-and 2-year overall survival rates were 83.8% and 51.4%, respectively. Compared with the hilar limited hepatectomy group, the extended hepatectomy group had significantly longer median disease-free and overall survival (P < 0.05). The 1-and 2-year disease-free and overall survival rates were higher for the extended hepatectomy group. There was no significant difference in morbidity and mortality between the two groups (P > 0.05).

  Conclusions  Extended hepatectomy is a safe operation that delays recurrence at early time points and improves the prognosis for patients with typeⅢand ⅣHC.