Extended liver resection for locally advanced intrahepatic cholangiocarcinoma (LAICC) shows promising outcomes, challenging previous doubts about surgical futility.

• 90-day mortality is low at 5% with an overall morbidity of 56%.
• Median overall survival is 58 months; recurrence-free survival is 23 months.

Nodal status is crucial for prognosis—patients with nodal involvement had significantly lower survival rates.

• R1 resection does not adversely impact overall or recurrence-free survival, supporting a more aggressive surgical approach.