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Pancreatic cancer incidence in India is low. Over the years, refinements in technique of pancreatoduodenectomy (PD) may have improved outcomes. No data is available from India, South-Central, or South West Asia to assess the impact of these refinements.

To assess the impact of service reconfiguration and standardized protocols on outcomes of PD in a tertiary cancer center in India.

Three specific time periods marking major shifts in practice and performance of PD were identified, viz. periods A (1992–2001; pancreaticogastrostomy predominantly performed), B (2003–July 2009; standardization of pancreaticojejunal anastomosis), and C (August 2009–December 2011; introduction of neoadjuvant chemo-radiotherapy and increased surgical volume).

500 PDs were performed with a morbidity and mortality rate of 33% and 5.4%, respectively. Over the three periods, volume of …