Non-benchmark patients with perihilar cholangiocarcinoma can achieve good outcomes despite higher complexity.

• 64% of 648 patients analyzed were classified as non-benchmark, with median overall survival at 46 months.
• Postoperative liver failure occurred in 16.7%, bile leakage in 22.8%, and in-hospital mortality was 2.9%, all within benchmark limits.

Choose treatment strategies carefully: complexity impacts survival significantly, with 5-year rates dropping from 50.5% in medical only to 15.4% in dual patients.

• Left trisectionectomy had the highest mortality rate at 9.5%.