Achieving a textbook outcome (TO) significantly enhances overall survival in biliary tract cancer (BTC) post-hepatectomy.

• Patients who achieved TO had a 31% reduced hazard of mortality (HR 0.69, 95% CI 0.58-0.82).
• Thirteen predictors of TO were identified, including younger age (OR 1.61), lower ASA score (OR 1.83), and smaller tumor size (OR 1.08).
• Laparoscopic surgery increased the likelihood of achieving TO (OR 2.65), while lymph node negativity was also a strong predictor (OR 1.84).

Identifying high-risk candidates early can optimize preoperative factors and improve surgical outcomes.