Pancreaticoduodenectomy (PD) has emerged as the standard surgical approach for the treatment of biliary and pancreatic tumors. This procedure effectively excises tumors, alleviates obstructive symptoms, and extends patient survival. With the promotion of the Enhanced Recovery After Surgery (ERAS) concept, accelerated rehabilitation strategies following PD have been increasingly adopted in clinical practice. Despite its widespread clinical application, postoperative rehabilitation remains fraught with challenges. This review aims to systematically summarize the factors influencing the efficacy of enhanced recovery after PD, to analyze potential barriers to postoperative rehabilitation, and to explore strategies for optimizing patient recovery through early intervention. Ultimately, this review seeks to provide practical guidance for healthcare professionals, with the goal of improving surgical outcomes and enhancing patients’ quality of life.