AIM To discuss the effect of surgical procedures on the prognosis of patients of bile duct cancer and their indications. METHODS A retrospective analysis was made for 52 cases of hepat oportal bile duct cancer treated from January 1991 to December 1996. All the cases were classified according to the modified Bismuth-Corlettle system and received appropriate operation. Therapeutic effects were valuated on the basis of their survival rates, jaundice elimination, comfort index, operative mortality and complications. RESULTS Seventeen cases received surgical resection (32.7%). The urvival rate was 71.4%, 35.7% and 10.4% forone, two and three years respectively, and was 30%, 16.8% and 0% for those with drainage (P<0.05). The mortality rate was 6.0% for the drainage group and 5.9% for the resection group (P>0.05). Of the 17 resected patients, 8 (47.1%) had curative resection and 9 (52.9%) noncurative resection. Their mean survival time was 21.1 months and 7.5 months respectively (P<0.05). CONCLUSION Proper surgical procedure should be used on the basis of the local and general conditions of the patients, and aggressive resection with or without liver resection is a valid rocedure for the treatment of hepato portal bile duct cancer and can significantly improve the rognosisof patients.