Background <p>Cancer-related distress is associated with low quality of life and oncologic outcomes in cancer patients. At present, there are limited data regarding the clinical implications of distress in patients with pancreatic cancer. The present study aimed to investigate the association between distress at diagnosis and the surgical outcomes of patients with curative-intent surgery for pancreatic cancer.</p> Methods <p>Since 2014, distress thermometer (DT) surveys have been distributed to all patients with presumed cancer in the outpatient clinic of Samsung Medical Center. We retrospectively reviewed the clinicopathological data of patients who underwent curative-intent surgery for pancreatic cancer between 2014 and 2021. The survival of the patients according to DT score was analyzed using Kaplan-Meier graph and z-test. Risk factor analysis was performed to identify the impact of distress on postoperative complications.</p> Results <p>Among 1,050 patients with pancreatectomy, 130 patients responded to a DT survey. Thirty-three (25.4%), 67 (51.5%), and 30 (23.1%) patients presented with mild, moderate, and severe distress, respectively. In the stage II group, patients with moderate distress showed better survival compared to those with mild or severe distress. Higher body mass index (<i>p</i> = 0.043) and severe distress at diagnosis (<i>p</i> = 0.034) were found to be independent risk factors for major complications.</p> Conclusion <p>More than 70% of the patients had moderate to severe distress at diagnosis. Distress was associated with increased risk of major complications after pancreatectomy. Further research is needed to explore the potential effect of distress on outcomes of patients with pancreatic cancer.</p>