Background and Objectives: Intrahepatic cholangiocarcinoma (iCCA) is a highly malignant biliary tumor associated with a poor prognosis. Here, we explored conversion therapy (CT) for the treatment of locally advanced iCCA (LA‐iCCA).Methods: We retrospectively enrolled 115 patients with LA‐iCCA at our single center from January 2019 to June 2024, with the final follow‐up conducted in January 2025. The primary outcome measured was overall survival (OS), while the secondary outcome focused on progression‐free survival (PFS). We utilized a propensity score matching (PSM) approach to adjust for potential confounders between the CT group and the systemic therapy (ST) group.Results: Before PSM, the median OS was 34.57 months (95% CI: 19.22–49.91), while the median PFS was 17.30 months (95% CI: 12.89–21.71) in the CT group. Both OS and PFS were significantly longer than those in the ST group (both p < 0.001). After PSM, both groups were successfully matched, resulting in 31 patients in each group. In the CT group, the median OS and PFS were 45.53 months (95% CI: 29.19–61.87) and 18.23 months (95% CI: 7.02–29.45), respectively. Both values were significantly higher than those in the ST group, with P values of less than 0.001 for OS and 0.002 for PFS. Furthermore, CT was identified as an independent factor associated with improved outcomes, both before and after PSM.Conclusions: CT was an effective approach for improving outcomes in patients with LA‐iCCA.