Adjuvant radiotherapy improves survival for patients with margin-negative, node-positive pancreatic ductal adenocarcinoma after surgery.

• Median overall survival (OS) for adjuvant radiotherapy patients was 26.0 months versus 24.1 months for those without it (p < 0.001).
• Stage IIb patients benefited most, showing a notable OS improvement; no difference was seen in Stage III patients.

Consider adjuvant radiotherapy for appropriate Stage IIb patients to enhance outcomes after pancreaticoduodenectomy.

• Analysis included 20,974 patients, predominantly Stage IIb (92.8%).