Background <p>Resection of perihilar cholangiocarcinoma (pCCA) is associated with significant perioperative morbidity and mortality. We sought to evaluate surgical outcomes following resection of pCCA over time.</p> Methods <p>Patients who underwent curative-intent resection with hepatectomy for pCCA at a single institution were divided into two cohorts based on date of resection: past cohort (1996–2013), and recent cohort (2014–2023).</p> Results <p>The study included 100 patients: 55 (55%) in the past (1996–2013) and 45 (45%) in the recent (2014–2023) cohorts. There were no differences between cohorts in age, sex, or Bismuth-Corlette classification between the two cohorts. Preoperative cholangitis was less common in the recent cohort (31% vs. 53%, <i>p </i>= 0.03). The proportions of right and left hepatectomies were similar in both cohorts. However, for patients with Bismuth-Corlette types I, II, and IV tumors (<i>n </i>= 35), left hepatectomy was more frequently performed in the recent cohort (61% vs. 13%, <i>p </i>= 0.005). There were trends toward lower rates of major complications (38% vs. 55%, <i>p </i>= 0.095) in the recent cohort. There was significantly less perioperative mortality (2% vs. 15%, <i>p </i>= 0.039) and no postoperative hepatic insufficiency in the recent cohort (0% vs. 20%, <i>p </i>= 0.001). Median recurrence-free survival was similar in the past and recent cohorts (29 vs. 37 months, respectively; <i>p </i>= 0.560), but median overall survival was improved in the recent cohort (33 months vs. not reached, <i>p </i>= 0.009).</p> Conclusions <p>Perioperative management to reduce preoperative cholangitis and liver insufficiency, advances in surgical technique, and consideration of left-sided hepatic resection have resulted in significantly improved outcomes in patients undergoing hepatectomy for pCCA.</p>