*Purpose: Recurrence of intrahepatic cholangiocarcinoma (ICC) after liver resection (LR) remains high and optimal therapy for recurrent ICC is challenging. Herein we assess the outcomes of patients undergoing repeat resection for recurrent ICC in a large, international multicenter cohort.

*Methods: Outcomes of adults from 6 large hepatobiliary centers in North America, Europe, and Asia with recurrent ICC following primary LR between 2001 and 2015 were analyzed. Cox models determined predictors of post-recurrence survival.

*Results: Of patients undergoing LR for ICC, 499 developed recurrence. The median time to recurrence was 10 months and 47% were intrahepatic. Overall 3-year post-recurrence survival was 28.6%. 123 patients (25%) underwent repeat resection, including 74 (61%) repeat LR. Surgically treated patients were more likely to have solitary intrahepatic recurrences and significantly prolonged survival compared to those receiving locoregional or systemic therapy alone (Figure 1) with a 3-year post-recurrence survival of 47%. Independent predictors of post-recurrence death included time-to-recurrence <1 year (HR 1.63 [1.29-2.05], p < 0.001), site of recurrence (HR 1.68, [1.23-2.29], p = 0.001), macrovascular invasion [HR 1.30, [1.03-1.90], p = 0.030), and size of recurrence > 3 cm [HR 1.64, [1.20-2.25], p = 0.002). Repeat resection was independently associated with decreased post-recurrence death [HR 0.59 [0.44-0.79], p < 0.001).

*Conclusions: Repeat resection for recurrent ICC in select patients can result in extended survival and potential cure, thus challenging the paradigm of offering these patients locoregional or chemo/palliative therapy alone as the mainstay of treatment.

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