Hilar cholangiocarcinoma (HCCA) is a malignant tumor that originates from the epithelial cells of the bile ducts, occurring in the left or right hepatic duct, the hepatic duct confluence region, or the proximal segment of the common hepatic duct. Its complex pathogenesis, insidious onset of symptoms, and special anatomical location lead to most patients being diagnosed at an advanced stage, making it a challenging aspect of clinical diagnosis and treatment. Only about 20% of patients can receive radical resection, with a R₀ resection rate ranging from 50% to 92%. The postoperative recurrence rate is high, and the prognosis is generally poor, with 5-year survival rates ranging from only 10% to 42%. Currently, surgical resection remains the main approach to improve the prognosis. With advancements in various surgical techniques, some progress has been made in the surgical treatment of HCCA, but it still faces numerous challenges. In this review, the authors provide an overview of the latest research progress and related controversies concerning the surgical treatment of HCCA.