Surgical outcomes for perihilar cholangiocarcinoma are significantly better now due to lower failure-to-rescue rates.

• Major complication rates rose from 36.2% to 40.8%, but failure-to-rescue rates dropped from 29.2% to 9.7%.
• Overall survival improved, largely driven by effective rescue strategies despite increased surgical complexity.

Multidisciplinary care is crucial for managing this high-risk malignancy and enhancing patient outcomes.

• The proportion of patients receiving extended hepatectomy and vascular resection has increased over time.