Younger patients with intrahepatic cholangiocarcinoma (IHC) show significantly better outcomes when unresectable compared to older patients, which may influence surgical decision-making.

• The median overall survival for the entire cohort was 23 months, with younger patients having longer overall survival when unresectable (p = 0.008).
• In the surgical group, older patients had better recurrence-free survival (27 vs 17 months).

Surgeons should consider age-related differences when evaluating treatment options and prognosis for IHC patients.

• Common genetic mutations were found in both age groups, with no genomic differences driving the observed survival disparities.