Surgeons need to reconsider the staging of multifocal intrahepatic cholangiocarcinoma as all cases should be classified as AJCC stage III, impacting surgical decision-making.

• Patients with multifocal tumors showed worse overall survival (26.1 vs. 60.0 months) and disease-free survival (9.8 vs. 25.0 months) compared to solitary tumors of stage II.
• Genomic profiling revealed that both satellite lesions and intrahepatic metastasis share a clonal origin, indicating they are manifestations of the same disease progression.

Recognizing the clonal nature and poor prognosis of multifocal lesions can guide patient selection for curative-intent surgery.