Objective: To evaluate the methods and efficacy of surgical treatment for type III and IV hilar cholangiocarcinoma. Methods: The clinical data of 16 patients with type III or IV hilar cholangiocarcinoma undergoing surgical treatment from April 2011 to February 2013 were retrospectively analyzed. Results: Surgical resection was performed in 13 of the 16 patients, and the resection rate was 81% (13/16), with radical resection (R0 resection) in 7 cases and non-radical resection in 6 cases. Three patients underwent left hepatectomy plus caudate lobectomy with reconstruction of the right hepatic duct and Roux-en-Y hepatojejunostomy, 3 patients received right hepatectomy plus caudate lobectomy with reconstruction of the left hepatic duct and Roux-en-Y hepatojejunostomy, and 7 patients received quadrate lobectomy plus perihilar resection with basin-type cholangiojejunostomy, and two of them with total bilirubin level more than 400 mmol/L were subjected to percutaneous transhepatic cholangio-drainage (PTCD) before surgical resection. Surgical resection could not be performed in 3 patients, of whom 2 cases had involvement of the left and right branches of the portal vein, one case was found having multiple intrahepatic metastases, and all the 3 patients underwent dilatation of the intrahepatic bile ducts and tube placement for drainage. The postoperative serum total bilirubin levels in all patients were markedly decreased or even returned to normal after surgery, and the effective rate of drainage was 100%. One death occurred during the perioperative period. Conclusion: For type III and IV hilar cholangiocarcinoma, tumor resection and relief of biliary obstruction should be strongly considered. A solid knowledge of biliary anatomy in the porta hepatis, skillful surgical technique and meticulous dissection are essential for improving the resection rate.