Objective To investigate the surgical effect of combined hepatectomy and survival conditions in patients with hilar cholangiocarcinoma (HCCA). Methods The research subjects included 93 patients with HCCA receiving combined liver resection in Nankai Hospital of Tianjin between January 2006 and December 2016. They were divided into a small area resection group (25 cases) and a large area resection group (68 cases) according to the scope of the liver resection. The postoperative survival condition was compared between the two groups. Multivariate Cox risk regression analysis model was used to explore the influencing factors of survival. Results The pathological results showed that 44 patients (74.2%) met the R0 resection standard, but there was no significant difference in R0 resection rate between the two groups (P > 0.05). The incidence of perioperative complications was not significantly different between the two groups (P > 0.05). There was no significant difference in postoperative 1-, 3- or 5-year survival rate between the two groups (P > 0.05). The preoperative CA199 >150 ku/L, poor tumor differentiation, TNM stage Ⅲ or Ⅳ, and positive incisal margin under microscope were the independent risk factors for poor postoperative prognosis (P < 0.05). Conclusions The curative effect of combined hepatectomy in patients with HCCA is not ideal. The preoperative CA199 >150 ku/L, poor tumor differentiation, TNM stage Ⅲ or Ⅳ, and positive incisal edge under microscope are the independent risk factors for poor postoperative prognosis of the patients, which has nothing to do with the scope of liver resection. Therefore, in guarantee of negative incisal edge, small-scale liver resection may be considered.