Intrahepatic cholangiocarcinoma (ICC) is considered to be a fatal disease because of frequent recurrence despite curative surgery. The macroscopic classification of ICC in the General Rules for the Clinical and Pathological Study of Primary Liver Cancer of the Liver Cancer Study Group of Japan reflects tumor-spreading patterns; therefore, the clinicopathological findings and surgical outcomes can be predicted using this classification. Lymph node and intrahepatic metastases, and a curative resection are important prognostic factors in ICC; however, lymph node dissection is still controversial. In particular, the intraductal growth type and periductal infiltrating type of ICC without hilar invasion have favorable surgical outcomes, whereas the mass-forming type and periductal infiltrating type of ICC with hilar invasion have high hepatic recurrence and local recurrence, respectively. Multimodal treatments are therefore needed to improve the surgical outcomes of ICC.