Extrahepatic bile duct resection shows lower complications but worse survival compared to pancreaticoduodenectomy in early-stage cholangiocarcinoma.

• Major complications: 5.9% for bile duct resection vs 45.3% for pancreaticoduodenectomy (p < .01)
• Length of stay: 11 days for bile duct resection vs 25 days for pancreaticoduodenectomy (p < .01)
• 5-year overall survival: 38.9% with bile duct resection vs 60.4% with pancreaticoduodenectomy (both p < .01)

Surgeons should prioritize pancreaticoduodenectomy as the standard approach whenever possible, reserving bile duct resection for select patients who are not surgical candidates for the more extensive procedure.