Background. Surgical resection of perihilar cholangiocarcinoma (pCCA) offers the only chance for long-term survival, but it is associated with high morbidity and mortality rates. The aim of this monocentric retrospective cohort study was to analyze clinical and oncological outcomes after curative resection of pCCA and to determine prognostic factors. Methods. Ninety consecutive patients (F/M ratio 36/54; median (range) age 64 (30-80) years) with pCCA underwent surgical resection with curative intent between 1998-2017. An R0-resection was obtained in 76 (84%) patients. Systemic chemotherapy was given in 4 patients before and in 14 patients after surgery. The impact of 23 prognostic factors on survival was evaluated using univariable and multivariable Cox regression models. Patients were followed up until death or until the date of study closure on December 2018, with a median follow-up time of 23,6 (0–236) months. Results. Postoperative complications occurred in 74 (82%) patients. Severe complications (TOSGS grade >3a) were observed in 42 (47%) patients, including 8 (9%) deaths. Median OS time was 31 (23–44) months and DFS 29 (20-52) months. OS and DFS rates at 5 and 10 years after surgery were 32.7% and 19.2%, and 36.3% and 29.8%, respectively. Independent predictors of OS were intraoperative blood transfusion (HR 2.218, CI 1.151-4.342, p=0.017), depth of tumor wall penetration (pT; HR 2.573, CI 1.168-5.215, p=0.021) ), locoregional lymph node metastasis (pN; HR 1.877, CI 1.043-3.427, p=0.035), and tumor differentiation grade (pG; 2 vs1: HR 3.601, CI 1.428-10.085, p=0.006; pG 3 vs1: HR 3.124, CI 1.163-9.096, p=0.023). Independent predictors of DFS were portal vein resection (HR 2.723, CI 1.258-5.871, p=0.011) and locoregional lymph node metastasis (pN; HR 2.198, CI 1.017-4.700, p=0.045). Conclusion. Curative surgery for perihilar cholangiocarcinoma is a high-risk procedure with poor long-term survival. Tumor characteristics (pT, pN, pG) and intra-operative blood transfusion determine overall survival.