Surgical approach impacts outcomes in intrahepatic cholangiocarcinoma.

• Only 38.8% of patients achieved R0 resection and lymphadenectomy, with open liver resection at 51.1%, robotic at 44.4%, and laparoscopic at just 14.5% (p < 0.001).
• Laparoscopic liver resection showed the best overall survival rates at 95% and 89% at 1 and 3 years, respectively, compared to open (79%/30%) and robotic (90%/81%) approaches (p < 0.001).

Prioritize laparoscopic techniques for better survival outcomes, despite lower benchmark compliance.

• Tumor multiplicity was identified as a significant predictor of mortality (HR = 2.18, p = 0.003).