Preoperative chemotherapy in perihilar cholangiocarcinoma shows similar surgical outcomes to those who do not receive it.

• Chemotherapy group had 52% morbidity and 4% mortality, with main complications like surgical site infections (27%) and bile leakage (26%).
• No significant differences in operative time, blood loss, or pathology outcomes after matching 80 patients per group.

Preoperative chemotherapy does not worsen surgical or pathological outcomes, guiding better patient selection.

• Five-year survival rates were nearly identical: 32.7% for the chemotherapy group vs. 30.9% for controls.