Preoperative and postoperative circulating tumor DNA (ctDNA) are crucial for predicting outcomes in pancreatic cancer patients undergoing surgery.

• Preoperative ctDNA presence linked to 2.08-fold higher risk of disease-free survival (DFS) and 2.31-fold increased risk of overall survival (OS).
• Postoperative positivity raises the risk of DFS by 3.29 times and OS by 3.42 times.

Monitoring ctDNA can refine patient selection for neoadjuvant, surgical, and adjuvant therapies, enhancing personalized treatment strategies.