BACKGROUND: Delayed recovery after pancreaticoduodenectomy (PD) is believed to preclude adjuvant therapy for approximately 30% of patients who undergo elective PD as initial treatment for pancreatic adenocarcinoma. This study reexamined the frequency of delayed recovery and assessed other factors associated with adjuvant therapy administration after PD at a high-volume center. STUDY DESIGN: Preoperative and perioperative variables were reviewed in a consecutive series of 85 patients with pancreatic adenocarcinoma undergoing PD without preoperative chemotherapy or radiotherapy from 1990 to 2004. RESULTS: Study groups included patients undergoing emergency PD (group 1, n=13); elective PD with good preoperative Eastern Cooperative Oncology Group (ECOG) performance status (PS) (group 2, ECOG PS: 0 to 1, n=63); and elective PD with marginal preoperative PS (group 3, ECOG PS: 2 to 3, n=9). Delayed recovery of PS precluded adjuvant therapy in 23% of patients in group 1, 6% of patients in group 2, and 44% of patients in group 3 (p=0.0001). CONCLUSIONS: The impact of delayed recovery after PD on the delivery of adjuvant therapy depends on the urgency of surgery and the preoperative PS. For patients with good preoperative PS who undergo elective PD at a high-volume center, it is uncommon for delayed recovery to preclude delivery of adjuvant therapy.