A newly optimized classification model better predicts postoperative pancreatic fistula risk in patients undergoing pancreatoduodenectomy for periampullary tumors.

• Overall, the rate of clinically relevant pancreatic fistula was 22.2%, rising to 25.8% specifically for periampullary tumors.
• The original model showed moderate predictive performance (AUC = 0.632), but the adjusted version improved this to 0.672.

Understanding these risk factors helps tailor preoperative assessment and decision-making for surgeons managing these complex cases.

• Key predictors included a soft pancreas, BMI ≥ 23 kg/m², and a pancreatic duct diameter ≤ 3 mm.