To explore the influencing factors for achieving textbook outcome (TO) after laparoscopic pancreaticoduodenectomy (LPD) in elderly patients with malignant tumors, and the relationship between TO and long-term prognosis.

A retrospective analysis was conducted on the clinicopathological data of elderly patients with malignant tumors who underwent LPD at our center between Mar. 2017 and Mar. 2025. Variables with a significance level of P<0.05 in the univariate analysis were included in a multivariate logistic regression analysis to identify independent risk factors for failure to achieve a TO postoperatively.

This study included a total of 351 patients, among whom 215 achieved a TO, while 136 did not. The long-term prognosis of patients in the TO group was significantly better than that of the non-TO group(P<0.05). The multivariate logistic regression analysis revealed that preoperative BMI (OR 1.095; 95%CI: 1.016-1.180; P=0.018), firm pancreatic texture (OR 0.568; 95%CI: 0.367-0.934; P=0.025), main pancreatic duct diameter (OR 0.748; 95%CI: 0.616-0.909; P=0.003), and postoperative delayed gastric emptying (OR 5.036; 95%CI: 2.354-10.770; P<0.001) were independent risk factors for failure to achieve a TO.

High preoperative body mass index(BMI), soft pancreatic texture, narrow main pancreatic duct diameter, and postoperative delayed gastric emptying are independent risk factors for failure to achieve TO in elderly malignant tumor patients after LPD. TO is associated with long-term survival in these patients.