A novel TNM staging system offers improved prognostic insight for intrahepatic cholangiocarcinoma, impacting surgical decision-making and patient outcomes.

• In a study of 496 patients, five-year survival rates surpassed 80% for specific tumor types (≤50 mm intraductal, ≤20 mm mass-forming without vascular invasion).
• The new system classified survival more accurately than the AJCC, especially for tumors with vascular invasion and lymph node involvement.

Surgeons should adapt to this new classification to better inform surgical candidates and outcomes.

• Tumors with extrahepatic vascular invasion had a median survival of 8.4-16.2 months, highlighting the need for careful assessment pre-operatively.