A new preoperative scoring system enhances risk stratification for clinically relevant postoperative pancreatic fistula (cr-popf) after pancreatoduodenectomy, potentially improving surgical outcomes.

• The 6-point score boasts an area under the ROC curve of 0.89, with 81.8% sensitivity and 91.7% specificity.
• cr-popf incidence is 4.6% in low-risk patients versus 82.5% in very-high-risk patients.

Implementing this tool allows for tailored surgical plans and preventive measures, potentially reducing complications.

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