Background <p>This study aimed to evaluate the association between lymph node dissection (LND) and Textbook Outcomes (TO) in patients with intrahepatic cholangiocarcinoma (ICC).</p> Methods <p>This retrospective multicenter study was registered in the Research Registry (registration number: researchregistry10392). We included patients treated at four major hospitals between 2011 and 2017. TO was defined as negative surgical margins, no perioperative blood transfusion, no postoperative complications, no prolonged length of stay (LOS ≤ the 50th percentile of the total cohort), no readmission within 30 days after discharge, and no postoperative death within 30 days. A random forest algorithm was used to determine the relative importance of factors associated with TO achievement. Subgroup analyses were conducted to identify patients who may benefit from LND. Adjusted TO was defined as achievement of both the conventional TO criteria and LND.</p> Results <p>A total of 376 patients were included in this study. Random forest analysis showed that LND was associated with the likelihood of achieving TO. Patients who underwent LND had higher rates of postoperative complications and longer hospital stays. Further analyses indicated that LND did not adversely affect overall prognosis and may contribute to prognostic stratification.</p> Conclusions <p>LND may reduce the rate of achieving TO in the short term; however, its value for long-term prognosis and postoperative treatment planning should not be overlooked.</p>