Introduction : Recurrence of intrahepatic cholangiocarcinoma (ICC) after curative resection is common and the prognosis of recurrent ICC is dismal.

Methods : This study was designed to investigate the patterns, timing, and prognosis of disease recurrence after curative-intent resection for ICC.

Results : A total of 147 patients were included. With a median follow-up of 21 months, 101 patients (68.7%) experienced ICC recurrence. In the cohort, 12 patients (11.9%) recurred at the surgical margin, 28 (27.7%) recurred within the liver away from the surgical margin, 41 (40.6%) recurred at extraheptatic sites, and 20 (19.8%) developed both intrahepatic and extrahepatic recurrence. More than 70% (70.3%) of all recurrence occurred within a year after primary surgical resection. Extrahepatic-only recurrence (median 7.8 m) and Both intrahepatic and extrahepatic recurrence (median 5.4 m) tended to occur early, while intrahepatic recurrence at non-margin sites occurred later (median 10.2 m; p = 0.027, and p = 0.003, respectively). Median survival after recurrence was better among patients with intrahepatic recurrence (29.2 months) or extrahepatic recurrence (10.6 months) or locoregional recurrence (21.2 months) was better than patients with both intrahepatic and extrahepatic recurrence (4.4 months) [p < 0.001, p = 0.024, and p = 0.045, respectively]. Median survival after recurrence was better among patients who tried any treatment modality (18.5 months) than patients who did not received treatment (5.0 months) [p < 0.001].

Conclusions : Different recurrence patterns, timing of recurrence, and prognosis suggest biological heterogeneity of ICC. Proactive treatment for recurrent ICC can be helpful to prolong the survival length of patients with recurrent ICC.