Purpose <p>This study aimed to explore the value of neutrophil-to-platelet ratio (NPR) in predicting postoperative prognosis of distal cholangiocarcinoma(dCCA).</p> Methods <p>The optimal cutoff value of NPR was determined using a receiver operator characteristic curve (ROC) analysis. Patients were divided into low- and high-NPR groups, and perioperative data and long-term survival were compared. Independent risk factors for postoperative tumor recurrence and long-term survival were identified using univariate and multivariate analyses. An NPR-based prediction model was established and verified using ROC, calibration curve, and decision curve analyses.</p> Results <p>A total of 168 patients were included. The area under the ROC curve of preoperative NPR was 0.617, and the optimal cutoff value was 0.014. Postoperative disease-free survival and overall survival were significantly longer in the low-NPR group. Univariate and multivariate analyses indicated that NPR &gt; 0.014 was an independent risk factor for postoperative recurrence (<i>RR</i> = 1.745, 95%<i>CI</i>: 1.027–2.965) and long-term survival (<i>RR</i> = 1.837, 95%<i>CI</i>: 1.127–2.993). The NPR-based prediction model could improve the predictive ability for the postoperative prognosis. Patients with a high preoperative NPR may have an advanced TNM stage and portal vein invasion.</p> Conclusion <p>Elevated NPR is an independent risk factor for postoperative tumor recurrence and a poor long-term prognosis in patients with dCCA.</p>