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In the DS9 episode, "Tacking into the Wind", Worf beat Gowron in mortal combat, thus making him the new Chancellor of the Klingon Empire. He quickly denies that and hands it over to Martok. How would things have gone differently if he had accepted? Would the Klingon Empire change? How would the Klingon Empire change?

Would many Klingons accept his legitimacy? He's spent most of his life in the Federation, suffered discommendation, and had his house dissolved.

I imagine lots of leadership challenges in his reign.

The Sins of the Father saga in TNG ends with Worf more or less turning his back on the 'klingon way' as it had been shown to him, and instead going his own way. This was reiterated in DS9, and it's a recurring theme throughout the show that Worf isn't very well liked by other klingons. He has his own code of honour which conflicts with the klingon one, which is ironic but I suppose inevitable given he was raised by humans.

I think he wouldn't be successful as Chancellor of the Klingon Empire. For all the reasons gandz says, but also he is too good a person to be a leader of klingons. Someone like Martok is about the only really decent klingon you're ever likely to find, and even he had moments where he was a prick. For that matter, as far as I'm concerned, I think someone like Worf deserves his own ship and ought to remain in Starfleet.

^
It's about bloody time, Worf got a Captaincy and his own ship.
For all his 'Worf Moments' getting his ass kicked by every Bravo alien, to show how badass they are by beating up on Worf (which unfortunatly had the effect of making him a running joke), it would be good to see how he handles command and the obligatory crap that has to deal with being a decent Captain.
It's not like he doesn't understand humans, being raised amongst them and all (and he's certainly 'human' enough to feel guilty about paralyzing/killing that kid in by headbutting him in a soccer game as opposed 'Wauuuggh he died gloriously waauuggh!'..) and I'd think by now he'd have matured enough not to want to start a rumble to soothe his wounded 'I-feel-guilty-about-surviving-the-Khitomer-massacre-so-I-must-be-more-Klingon-than-you' pride, because 'That is not what Picard or Riker would have done'.

As to being the Chancellor...he would've probably have been snubbed at the very least. Or subordinate would take a very very very very long time, to get around to following his orders, and his mail would arrive late.

It would be interesting to see and likely Martok as the head of Worf's house and an admired General, would probably end up doing most of the work anyway but in this version of events he'd be more the power behind the throne type guy.

Thus explaining why Worf was so fast in giving up the Chanchellory: Martok was gonna do most of the work anyway, only without the glory.