Left hepatic trisegmentectomy has been performed for huge malignant tumors, but it is rarely applied in patients with hilar cholangiocarcinoma. Twelve consecutive patients (7 men and 5 women; mean age, 64 years) underwent left hepatic trisegmentectomy in our institution between January 2000 and December 2003. The preoperative management and postoperative outcomes of this surgical procedure were presented and retrospectively analyzed. Preoperative biliary drainage and portal vein embolization were performed in 6 patients (50%) and 9 patients (75%), respectively. The preoperative estimated volume ratio of the posterior segment /the whole liver was 44.8 +/- 7.0% (34.3-54.3), the plasma retention rate of indocyanine green at 15 minutes was 8.6 +/- 2.2% (4.7-13.7), and the serum total bilirubin level before surgery was 1.0 +/- 0.4 mg/dl (0.4-1.7). The serum total bilirubin level on the first postoperative day was 3.3 +/- 0.4 mg/dl (1.4-6.2). There was no hospital death or postoperative hepatic failure. The incidence of positive resectional margin was 25%. With biliary decompression and preoperative portal embolization techniques, left hepatic trisegmentectomy was a safe and curative resectional option for hilar cholangiocarcinoma.