A new preoperative risk score based on CT measurements can help surgeons predict clinically relevant postoperative pancreatic fistula (cr-popf) after pancreatoduodenectomy.

• 6-point score achieved an AUC of 0.89; sensitivity 81.8%, specificity 91.7%.
• Incidence of cr-popf varies widely: 4.6% in low-risk vs. 82.5% in very high-risk patients.

Use this scoring system for better surgical planning and targeted prevention strategies.

• Key risk factors include pancreatic attenuation ≤30 Hounsfield units, duct-to-parenchyma ratio ≤0.2, duct diameter <3mm, and BMI ≥25 kg/m².