BACKGROUNDS and AIM: Intrahepatic cholangiocarcinoma (ICC) is increasing worldwide and still remains a major challenge for surgeons with around 30% of 5-year survival rate after curative resection. The results of surgical resection for ICC patients with lymph node metastases are especially poor. We herein evaluate our results of surgical resection for the patients with ICC.PATIENTS and METHODS: 44 patients with ICC underwent hepatectomy in our institute until 2006. They are including 13 patients with lymph node metastases. Survival rates after first hepatectomy for the patients were caluculated and cases of long-term survival were examined.RESULTS: Survival rates after first hepatectomy are 51,29,22% for 3, 5, 10 years, respectively. Survival rates of the patients with and without lymph node metastases are 42 and 51% for 3 years, and 28 and 29% for 5 years, respectively. There is no significant difference between the survival curves from the groups. 11 out of 13 patients with lymph node metastases have recurrences after first hepatectomy (7 in residual liver; 2 in lung, lymph node, each; 1 in bone, brain, peritoneum, each). 5 patients with lymph node metastases and 11 patients without actually survived more than 3 years. 4 out of those 5 patients with lymph node metastases underwent repeat surgery for recurrences in the residual liver or the lung and 3 of them underwent adjuvant and/or neo-adjuvant chemotherapy. There is one patient who underwent 4 hepatectomy and 1 pulmonary resection, combined with chemotherapy, and survived 6years and 9 months.CONCLUSION: In our series, the outcome of hepatectomy for ICC patients with lymph node metastases is comparable to that for patients without. Although recurrence rate after hepatectomy is high for the patients, the residual liver and the lung are the main sites of recurrence and repeat surgery, combined with chemotherapy, is thought to benefit their survival.