Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver cancer with a poor prognosis. Negative-margin resection is presently the only potentially curative treatment option. Emerging trends with direct applicability to surgical strategy include margin thickness, lymphadenectomy, optimization of future liver remnant (FLR), minimally invasive techniques, incorporation of systemic therapy, and reconsideration of liver transplantation. This review emphasizes areas of consensus and ongoing debate. Margins ≥5–10 mm are associated with improved results, but biology generally takes precedence over prognosis. Regional lymphadenectomy enhances staging accuracy, although its therapeutic benefit remains unsettled. PVE is standard for FLR enlargement, LVD provides faster hypertrophy, and ALPPS remains reserved for highly selective cases. Minimally invasive and robotic hepatectomy share oncologic results in skilled institutions. Systemic therapies, including immunotherapy and biomarker-directed targeted therapy, are increasingly being incorporated perioperatively. Liver transplant may be of potential value in early-stage disease or on strict indications after neoadjuvant treatment. The modern surgical management of iCCA encompasses a blend of oncologic considerations, FLR optimization, minimally invasive surgery, and systemic therapy according to tumor biology. Multidisciplinary planning and participation in clinical trials are necessary to align surgical innovation with advancements in molecular and systemic treatments, ultimately leading to improved long-term outcomes.
肝内胆管癌（iCCA）是第二常见的原发性肝癌，预后较差。目前，根治性切除是唯一可能治愈的治疗选择。直接影响手术策略的新趋势包括：切缘厚度、淋巴结清扫、未来剩余肝体积（FLR）的优化、微创技术、系统治疗的整合以及肝移植的重新考量。本综述重点探讨已达成共识和仍存争议的领域。切缘≥5–10毫米与改善预后相关，但肿瘤生物学特性通常比切缘厚度更优先影响预后。区域淋巴结清扫可提高分期准确性，但其治疗获益尚未明确。门静脉栓塞（PVE）是扩大FLR的标准方法，肝静脉剥夺（LVD）可实现更快的肝体积增生，而联合肝脏分割和门静脉结扎的分阶段肝切除术（ALPPS）仍仅适用于高度选择的病例。在技术成熟的机构中，微创和机器人肝切除术的肿瘤学结果相当。系统治疗（包括免疫治疗和生物标志物指导的靶向治疗）在围手术期的应用日益增多。肝移植可能对早期疾病或经新辅助治疗后严格符合指征的患者具有潜在价值。现代iCCA的外科治疗融合了肿瘤学考量、FLR优化、微创手术以及根据肿瘤生物学特性制定的系统治疗。为将外科创新与分子及系统治疗的进展相结合，最终改善长期预后，多学科规划及参与临床试验是必要的。
肿瘤(癌症)患者之家