Trisectionectomies significantly improve survival for patients with localized Bismuth-Corlette type II-III perihilar cholangiocarcinoma.

• Overall survival improved to 52.4 months with trisectionectomy vs. 31 months for extended hemihepatectomy (p < 0.001).
• R0 resection rates were higher with trisectionectomies (83.9% vs. 75.8%, p = 0.037).

Consider trisectionectomies for appropriate patients to enhance oncological outcomes without increasing significant morbidity or mortality risks.

• Grade B-C liver failure occurred more frequently with trisectionectomies (23.4% vs. 11.3%, p = 0.002).