Textbook outcomes in liver surgery link directly to better survival in gallbladder cancer patients.

• 61.9% of patients achieved textbook outcomes (TOLS) after curative-intent resection.
• The 5-year overall survival rate was 45.4% in the TOLS group compared to 21.9% for non-TOLS (p < 0.001).

Surgeons should prioritize achieving TOLS to improve long-term patient outcomes.

• Key risk factors for survival include total bilirubin >54 µmol/ml and poor differentiation, among others.