Neoadjuvant chemotherapy followed by surgery significantly improves survival and reduces recurrence in patients with potentially resectable intrahepatic cholangiocarcinoma.

• Median overall survival was 52.9 months for neoadjuvant therapy versus 37.0 months for upfront surgery.
• Recurrence risk was lower at 57.7% compared to 65.7%, and the time to relapse extended to 16.5 months from 10.7 months.

This evidence supports considering neoadjuvant chemotherapy as a standard approach for high-risk patients.

• Five-year survival rates reached 45.7% with neoadjuvant therapy, compared to 32.5% with upfront surgery.