Achieving an ideal outcome (io) after pancreatoduodenectomy for resectable pancreatic head cancer significantly improves overall survival and treatment continuity.

• In patients achieving io, the 5-year overall survival was 74.7% versus 46.0% for those who did not (p=0.011).
• io achievement led to 86.1% initiating adjuvant chemotherapy compared to 67.2% in the non-io group, with earlier initiation (postoperative day 44 vs. 56; p<0.001).
• Longer post-recurrence survival was noted in the io group (median 15 months vs. 6 months; p=0.009).

These findings underscore the importance of optimizing perioperative outcomes to enhance long-term survival in patients undergoing surgery for pancreatic cancer.