A new classification system helps predict pancreatic fistula risk after pancreatoduodenectomy.

• Overall postoperative pancreatic fistula (POPF) rate is 19.9%.
• Class D patients have a 37.4% POPF rate, significantly higher than Class A’s 9.0% (p < 0.001).

Surgical decision-making should incorporate this classification for better patient selection.

• Class D patients show a 6-fold increased risk of POPF compared to Class A.