Neoadjuvant therapy may significantly enhance post-recurrence survival in patients with intrahepatic cholangiocarcinoma.

• Patients receiving neoadjuvant therapy had a median post-recurrence survival of 31.9 months compared to 16.4 months for those who did not (p = 0.006).
• Neoadjuvant therapy was an independent predictor of survival (hazard ratio, 0.506; p = 0.008).

Consider integrating neoadjuvant therapy in high-risk patients to improve outcomes and explore targetable molecular alterations.

• Recurrence patterns remained stable over time, highlighting the need for ongoing treatment strategies post-recurrence.