Objective: To investigate the application and clinical efficacy of precise surgical technique in surgical treatment of hilar cholangiocarcinoma. Methods: The clinical data of 44 patients with hilar cholangiocarcinoma who received precise surgical treatment from May 2007 to December 2012 were retrospectively analyzed. Results: Of the 44 patients, 19 cases (43.2%) received R0 resection, 7 cases underwent R1 resection, 5 cases had R2 resection, 5 cases were subjected to a palliative operation, and 8 cases were treated with biopsy and internal or external drainage; 18 cases underwent combined liver resection, and 2 cases had simultaneous hepatic artery resection and reconstruction. The average operative time was (5.8±1.6) h and average intraoperative blood loss was (810±509) mL. Postoperative complications occurred in 28 cases and one case (1/44) died within one month. Thirty-nine patients were followed up for 4-62 months, and the overall 1-, 3- and 5-year survival rates were 67.7%, 30.8% and 10.6%, respectively. The 1-, 3- and 5-year survival rates for patients with R0 resection were 93.3%, 43.2% and 13.9%, and for patients undergoing non-radical resection were 50.5%, 26.8% and 0, respectively, and the postoperative survival in patients with R0 resection was significantly better than that in patients with non-radical resection (χ2=4.61, P<0.05); the 1-, 3- and 5-year survival rates for patients who underwent combined lobectomy were 94.1%, 52.7% and 11.8%, and for patients without combined lobectomy were 69.2%, 25.4% and 0 respectively, and the patients who received combined lobectomy had a significantly better postoperative survival rate than those without combined lobectomy (χ2=15.26, P<0.05). Conclusion: Use of precise surgical technique in surgical treatment of hilar cholangiocarcinoma can increase the radical resection rate, reduce postoperative complications and improve the therapeutic outcomes.