Recent progress in surgical techniques for and the perioperative management of hilar cholangiocarcinoma has led to improved outcomes for aggressive liver and bile duct resections, which, however, still show considerable morbidity and mortality. In this article, the results of pioneers' attempts in hepatobiliary surgery for difficult hilar cholangiocarcinomas are reviewed. It is recommended that curative hepatobiliary resection should be performed for hilar cholangiocarcinoma, with careful preoperative management of patients complicated with several difficult conditions.