Background and Aims Radical resection is the only potentially curative treatment for intrahepatic cholangiocarcinoma (ICC), yet the high recurrence rate results in poor prognosis. In recent years, "textbook outcome" (TO) has been proposed as a comprehensive quality metric, but its association with prognosis remains unclear. This study aimed to analyze the risk factors influencing the achievement of TO after radical resection of ICC and to explore the relationship between TO and survival.Methods A retrospective analysis was conducted on the clinical data of 180 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA between February 2018 and February 2023. Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with TO, and survival analysis was carried out using the Kaplan-Meier method and Log-rank test.Results Of the 180 patients, 66 achieved TO. Multivariate Logistic regression analysis indicated that preoperative total bilirubin >22 μmol/L, preoperative CA19-9 >35 U/mL, maximum tumor diameter >5 cm, poor tumor differentiation, microvascular invasion (MVI), and lymph node metastasis were independent risk factors for failing to achieve TO (all P<0.05). Survival analysis demonstrated that patients who achieved TO had a significantly longer median survival compared with those who did not (36 months vs. 16 months, P<0.001).Conclusion Preoperative total bilirubin >22 μmol/L, preoperative CA19-9>35 U/mL, maximum tumor diameter >5 cm, poor tumor differentiation, MVI, and lymph node metastasis are independent risk factors for not achieving TO after radical resection of ICC. Patients who achieved TO exhibited markedly longer survival, suggesting that TO not only reflects perioperative treatment quality but also serves as an important prognostic indicator. Greater attention to these risk factors and optimization of perioperative management may improve the likelihood of achieving TO and enhance long-term outcomes.