Achievement of the Ideal Outcome After Pancreatectomy for Pancreatic Ductal Adenocarcinoma Is Associated With Earlier Initiation and Higher Completion Rates of Adjuvant Chemotherapy and Improved Long‐Term Survival

ABSTRACT Background The Ideal Outcome is a composite quality indicator reflecting optimal postoperative course after pancreatic surgery. This study aimed to clarify the prognostic significance of achieving the Ideal Outcome and its influence on the initiation and completion of adjuvant chemotherapy. Methods We retrospectively analyzed 187 patients who underwent pancreatectomy for pancreatic ductal adenocarcinoma between 2016 and 2024. The Ideal Outcome was defined as absence of in‐hospital mortality, severe complications, grade B or C postoperative pancreatic fistula, reoperation, prolonged hospitalization (> 75th percentile), or 30‐day readmission. Associations with survival, timing and completion of adjuvant chemotherapy, and predictors of non‐achievement of Ideal Outcome were assessed. Results The Ideal Outcome was achieved in 56.7% of patients. Those who achieved it initiated adjuvant chemotherapy earlier and had significantly higher completion rates (64.2% vs. 43.2%; p = 0.004). In multivariate analysis, non‐achievement of the Ideal Outcome (HR = 1.82, 95% CI: 1.21–2.73; p = 0.004), tumor size ≥ 30 mm, and no adjuvant chemotherapy were independent prognostic predictors of poor overall survival. Similarly, non‐achievement of the Ideal Outcome (HR = 1.46, 95% CI: 1.14–2.35, p = 0.007), CA19‐9 ≥ 150 U/mL, tumor size ≥ 30 mm, and no adjuvant chemotherapy administration were identified as independent prognostic predictors of poor recurrence‐free survival. Age ≥ 80 years, cardiovascular disease, and soft pancreatic texture were independent predictors of not achieving the Ideal Outcome. Conclusions Achievement of the Ideal Outcome was associated with earlier initiation and higher completion rates of adjuvant chemotherapy, as well as improved long‐term survival after resection for pancreatic ductal adenocarcinoma.