Objective: To systematically evaluate the effect of combined vascular resection (VR) in surgical treatment of hilar cholangiocarcinoma (HCCA). Methods: The literature of studies comparing surgical treatment of HCCA in combination with VR versus that without VR was collected by searching several national and international databases. The safety and efficacy of combined VR were evaluated, and the subgroups analysis was also performed according to the types of the simultaneously resected blood vessel. Results: Twenty seven studies with a total of 3 218 HCCA patients were included, of whom 888 cases underwent combined VR treatment (VR combination group), and 2 330 cases had no combined VR treatment (control group). The results of Meta-analysis for overall group showed that the safety profile was unfavorable (mortality: OR=2.83, 95% CI=1.80–4.44; postoperative complications: OR=2.48, 95% CI=1.44–4.28) and the efficacy was less favorable (1-, 3- and 5-year overall survival: OR=0.60, 95% CI=0.49–0.73; OR=0.57, 95% CI=0.47–0.69; OR=0.61, 95% CI=0.41–0.91) in VR combination group compared with control group (all P<0.05). In portal vein resection subgroup compared with control group, although the incidence of complications was increased (P<0.05), no difference was found in other variables (all P>0.05); in hepatic artery resection subgroup, all the pooled results were consistent with the overall findings (all P<0.05). Conclusion: In HCCA patients, surgical treatment combined with VR is feasible for those with portal vein invasion, but VR should be made cautiously if the hepatic artery is involved.