Surgeons can better anticipate interventions for celiac axis stenosis (CAS) during pancreatoduodenectomy by assessing key preoperative factors.

• Of 1,042 patients, 85 (8.2%) had CAS, but only 11 (1.1%) needed intervention.
• Four preoperative predictors emerged: stenosis diameter ≤2 mm, stenosis rate ≥70%, gastroduodenal-to-common hepatic artery ratio ≥1.0, collateral artery diameter ≥3 mm.
• Interventions were unnecessary when none of these factors were present; all with three or more required action.

These insights can refine preoperative planning and resource allocation during surgery.