Hilar cholangiocarcinoma (HCCA) mainly occurs in the common hepatic duct, left and right hepatic duct, and their confluence, accounting for approximately 50.0% to 70.0% of all cholangiocarcinoma. It is a common malignant tumor of the biliary system, with the highest incidence in Asia. Currently, surgery is the only effective treatment for HCCA. Due to the lack of early or typical symptoms, patients often present with jaundice or significant abdominal pain, and the diagnosis is usually confirmed only when the disease has progressed. Additionally, the anatomical location of HCCA is special and complex, and the tumor exhibits biological characteristics of growth along the bile ducts and infiltrative growth. Therefore, the rates of radical surgical resection and long-term survival are relatively low. Surgical treatment of HCCA has made significant progress, but it remains a challenge for surgeons. There are still many controversies in surgical treatment, with new points of contention continually emerging, such as the necessity and methods of preoperative biliary drainage, solutions for inadequate remnant liver volume, the extent of liver resection, the scope of lymph node dissection, the value of combined vascular resection and liver transplantation, and application of minimally invasive surgery. The authors discuss these controversies based on the most recent literature, aiming to promote a correct understanding of HCCA, standardize its treatment, and improve patient prognosis.