To investigate the perioperative safety, radicality, and long-term prognosis differences between regional lymph node dissection and extended lymph node dissection in resectable hilar cholangiocarcinoma (PHCC), and to clarify the applicable population for different dissection ranges.

A cohort study was conducted to analyze the clinical data of 94 patients with PHCC who underwent radical resection from December 2020 to November 2024. The patients were divided into the regional dissection group (n=46) and the extended dissection group (n=48) based on the range of lymph node dissection. Statistical analysis was performed using SPSS26.0. The t test and χ² test were used to compare perioperative indicators and radical indicators between the two groups; the Kaplan-Meier method and Log-Rank test were used to compare the survival prognosis of the two groups. P<0.05 was considered statistically significant.

The operation time of the extended dissection group was longer than that of the regional dissection group (P>0.05). The total number of lymph nodes dissected, the number of positive lymph nodes, and the positive rate in the extended dissection group were higher than those in the regional dissection group. The 1-year, 3-year, and 5-year overall survival (OS) and recurrence-free survival (RFS) rates of the extended dissection group were higher than those of the regional dissection group; subgroup analysis showed that the extended dissection group had better prognosis in patients with Bismuth Ⅲ/Ⅳ type (P<0.05). Cox regression analysis showed that regional dissection, non-R0 resection, Bismuth Ⅲ/Ⅳ type, and the number of positive lymph nodes ≥ 3 were independent risk factors.

Extended lymph node dissection is safe and feasible for resectable PHCC, which can improve the accuracy of lymph node staging and improve the long-term survival of patients; patients with Bismuth Ⅲ/Ⅳ type are the core beneficiaries of extended dissection, and patients with Bismuth Ⅰ/Ⅱ type can meet clinical needs with regional dissection.