Background: Major hepatic resections in steatotic livers may carry high risk of postoperative liver failure unless preoperative biliary drainage is carried out.Aim: to analyze the results of surgical resection in hilar cholangiocarcinoma treated over an 18 year period and determine mortality and morbidity rates of hepatic resection in hilar cholangiocarcinoma and the factors affecting surgical outcome.Patients and methods: During the period 1987 to 2008, 84 hepatic resections were performed for Klatskin tumours. They included extended right hepatectomy in 7, right hepatectomy in 11, left hepatectomy in 25, extended left hepatectomy in 6, and parenchyma-conserving liver resections in 32 patients. In addition, 8 patients underwent resection and reconstruction of the portal vein, and two patients underwent reconstruction of the right hepatic artery. Median bilirubin levels were 10.6 mg/dl (range 4.3 to 27.6 mg %). Age, sex, comorbid illnesses, bilirubin levels, elevated liver enzymes, abnormal but correctable prothrombin time, operating time, intra-operative hypotension, blood loss, vascular resection, infected bile, and disease stage were examined for correlation with mortality and morbidity.Results: 7 patients died (mortality 8.3%). All the deaths were in the major hepatic resection group. On univariate analysis: operating time, intraoperative blood loss, hypotension, comorbid illnesses, bilirubin levels >20 mgs%, and vascular resection were risk factors for mortality. On multivariate analysis, however, concomitant vascular resection and intra operative blood loss and hypotension were the only factors correlating with mortality. 33 major complications occurred in 21 patients (39%). Conclusion: Safe hepatic resection for hilar cholangiocarcinoma can be carried out in patients with jaundice without preoperative biliary drainage. Concomitant vascular resection, and bleeding may however place the patient at risk for postoperative