Postoperative adjuvant therapy for pancreatic cancer has become the core component of comprehensive management. The mainstream regimens include gemcitabine monotherapy, gemcitabine combined with capecitabine, modified FOLFIRINOX, and gemcitabine combined with S-1. Full-dose and full-cycle chemotherapy is crucial to improving survival benefits for patients. Biomarkers such as circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA), as well as technologies such as patient-derived organoid (PDO) drug sensitivity testing and artificial intelligence-assisted transcriptomic analysis, provide important support for precise and individualized adjuvant therapy. Adjuvant radiotherapy, targeted therapy, and immunotherapy show potential in high-risk patients. Future research should focus on head-to-head comparisons of multiple regimens and molecular stratification guidance to optimize combination therapy strategies and continuously enhance survival benefits for patients.