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Background This study investigated the incidence of textbook outcome and its associated factors in patients with left-sided colorectal cancer (CRC) undergoing laparoscopic para-aortic lymph node (PALN) dissection.Methods We retrospectively analyzed patients with left-sided CRC who underwent laparoscopic primary tumor resection combined with PALN dissection at a high-volume tertiary center between May 2012 and July 2024. Textbook outcome was defined as a composite measure of optimal perioperative recovery, including no 30-day mortality, no 30-day unplanned readmission, no intraoperative complications, no conversion to open surgery, no ICU admission, no reintervention, no severe postoperative complications, retrieval of ≥4 PALNs, tumor-negative resection margins, and postoperative hospital stay ≤14 days ( IDDF2026-ABS-0118 Figure 1(A) The cumulative incidence of textbook outcomes and the status of indicators in different tumor locations).Results Textbook outcome was achieved in 50.3% (83/165) of patients. The distribution of individual textbook outcome components and comparisons by tumor location are shown in Figure 1A-B ( IDDF2026-ABS-0118 Figure 1(A,B) The cumulative incidence of textbook outcomes and the status of indicators in different tumor locations). Multivariable analysis identified lower ASA score, less estimated blood loss, and retrieval of ≥12 regional lymph nodes as independent factors associated with textbook outcome. Patients who achieved a textbook outcome showed better 3-year overall survival and disease-free survival, although the differences were not statistically significant (IDDF2026-ABS-0118 Figure 2(A,B) Kaplan-Meier curves of PALN dissection patients). A nomogram incorporating significant predictors was developed to estimate the probability of textbook outcome, with moderate discrimination (C-index = 0.708, 95% CI 0.633–0.784). Its predictive performance, calibration, and clinical utility are presented in Figure 3A-D (IDDF2026-ABS-0118 Figure 3(A-D) Nomogram predicting textbook outcome after resection of left-sided colorectal cancer patients after laparoscopic PALN dissection.Conclusions In this high-volume expert center, laparoscopic PALN dissection achieved a favorable textbook outcome rate in patients with left-sided CRC. Lower operative burden and more adequate lymph node dissection were associated with a higher likelihood of a textbook outcome. Prospective external validation is warranted before routine clinical adoption.Abstract IDDF2026-ABS-0118 Figure 1Abstract IDDF2026-ABS-0118 Figure 2Abstract IDDF2026-ABS-0118 Figure 3