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Background and study aim: Endoscopic ultrasound- guided fine needle aspiration (EUS-FNA) is frequently performed for suspected biliary tumors for diagnosis and staging but carries a theoretical risk of needle-track seeding. We aimed to evaluate the impact of preoperative EUS-FNA on long-term outcomes for patients with cholangiocarcinoma (CCA). Patients and methods: In a retrospective singlecenter study of consecutive patients with CCA with preoperative EUS-FNA,main outcomemeasures were overall survival and progression-free survival. Results: In 150 patients with confirmed CCA, 61 underwent preoperative FNA. Median overall survival was 18.5 months (95% confidence limits [CL] 15.4, 25.7): 111 patients died and 39 survived. Of the 150 patients, 119 underwent curative- intent surgical resection, with median progression- free survival of 17.8 months (95%CL 14.5, 22.8); 89/119 patients had tumor recurrence or died, and 30/119 remained alive and disease- free. On multivariable analysis, overall survival was associated with: undergoing curativeintent surgery (hazard ratio [HR] 5.79, P=0.001), lack of lymph node involvement (HR 1.89, P= 0.011), younger age (HR 1.51 for every 10 years, P<0.0015), and small tumor size (HR 1.11 for every 1cm, P=0.029). For patients undergoing curative- intent surgery, on multivariable analysis, improved progression-free survival was associated with: lack of lymph node involvement (HR 1.88, P=0.010), smaller tumor size (HR 1.16 for every 1cm smaller, P=0.003), and younger age (HR 1.53 for every 10 years, P<0.001). Number of needle passes showed no statistically significant impact on overall survival. Conclusion: Preoperative EUS-FNA in patients with CCA does not appear to adversely affect overall or progression-free survival. [ABSTRACT FROM AUTHOR]