Objective: To investigate the clinical effects and outcomes of palliative therapy in treatment of hilar cholangiocarcinoma. Methods: The clinical data of 218 patients with hilar cholangiocarcinoma treated in Xiangya Hospital of Central South University between December 2005 and November 2015 were retrospectively analyzed. Results: Of the 218 patients, 159 cases (72.9%) underwent palliative surgery that included external biliary drainage in 134 cases and internal biliary drainage in 25 cases, and 59 cases (27.1%) underwent interventional treatment that included percutaneous transhepatic biliary drainage (PTBD) in 27 cases and endoscopic retrograde biliary drainage (ERBD) in 32 cases. Two patients died within postoperative 30 d, and the total bilirubin levels were decreased significantly in patients either after palliative surgery or interventional treatment (both P<0.05). Two hundred and two patients were followed up and 196 patients died during this period. The median survival time, and the 1-, 3- and 5-year survival rates were 7 months, and 29.9%, 8.1% and 2.3% in the entire group of patients, which were 7 months, 33.8%, 10.3% and 2.9% in patients undergoing palliative surgery, and 7 months, 14.9%, 0 and 0 in patients undergoing interventional treatment, and the difference between the latter two groups had statistical significance (χ2=5.328, P<0.05). The survival rates between patients undergoing external biliary drainage and internal biliary drainage, or between patients undergoing PTBD and ERBD showed no statistical difference (χ2=0.673; χ2=0.023, both P>0.05). Conclusion: The long-term outcomes of palliative therapy for hilar cholangiocarcinoma are unfavorable. Both palliative surgery and interventional treatment have jaundice reduction effect, and survival rates in patients after palliative surgery are higher than those after interventional treatment, while interventional treatment has the advantages of simple operation and less trauma.