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Background: Pancreatic surgery often does not provide long-term survival in patients with cancer or consistently improve symptoms in benign disease. This study aimed to assess decision regret and satisfaction with the decision-making process among patients who underwent pancreatectomy., Methods: This study administered the Brehaut Decision Regret Scale (DRS), 9-Item Shared Decision-Making Questionnaire (SDM-Q-9), and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) to all patients who underwent elective pancreatectomies from 2021 to 2023. Decision regret was defined as a DRS of >25. In addition, this study evaluated SDM-Q-9 responses in patients with and without regret., Results: A total of 143 patients were included in this study, of whom 71 patients (49.6%) completed the distributed surveys. Demographics, pathology, and major complication rates were similar between responders and nonresponders. The indications for surgery were malignancy (67.6%) and benign disease (32.4%). Decision regret after pancreatic surgery was reported in 18.3% of patients. Patients who experienced regret were younger (50.8 ± 18.7 years [younger group] vs 62.0 ± 14.9 years [older group]; P = .03), more likely to have benign disease (39.1% [benign disease] vs 8.3% [malignant disease]; P < .01), underwent a distal pancreatectomy (34.5% [distal pancreatectomy] vs 7.7% [pancreaticoduodenectomy]; P = .02), or experienced a major complication (36.8% [major complication] vs 11.5% [no major complication]; P = .03). Patients with regret had lower global health (57.1 ± 20.1 [patients with regret] vs 76.2 ± 22.2 [patients without regret]; P < .01) and social function scores (61.5 ± 31.5 [patients with regret] vs 77.6 ± 22.0 [patients without regret]; P = .03) on the EORTC QLQ-C30. Patients with regret were less satisfied with the shared decision-making process., Conclusion: Strong decision regret was reported in 18% of patients who underwent pancreatectomy. Younger age, distal pancreatectomy, benign indications, and major postoperative complications were associated with regret. Data from the SDM-9 highlight areas for potential improvement to help patients make decisions aligned with their goals of care., (Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)