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.

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.

A prospective trial indicates a new ultrasound technique may improve detection of bile leaks during liver surgery.

• Contrast-enhanced intraoperative ultrasonic cholangiography was technically successful in 86.2% of patients.
• Postoperative bile leak rate was 17.2%, with most detected intraoperatively.

This approach could enhance surgical safety but requires further validation to confirm its impact on patient outcomes.

• No adverse events related to the injection were reported, and postoperative liver enzyme elevations were lower than historical standards.