Pancreaticoduodenectomy (PPPD) is one of the most complicated surgeries in abdominal surgery with extensive resection, large changes to the physiological structure of the patient, many intraoperative and postoperative complications, high surgical difficulty and operation. This procedure is also called Whipple procedure. Through the continuous efforts of surgeons, this procedure has become more and more standardized, and the complication rate and operative mortality rate have been decreasing, and it has become a classic procedure for treating lesions such as peri-pot belly cancer, but this procedure is mainly performed in tertiary hospitals. Diseases requiring pancreaticoduodenectomy mainly include the following four categories, but whether the surgery can be performed depends on whether the lesion is locally resectable and whether the patient’s systemic condition can withstand the surgical blow, and it may be necessary to make a final decision based on the results of the exploration during surgery. 1.Tumors with high malignancy mainly include peri-pot belly cancer, which refers to malignant tumors within 2cm of the pot belly, mainly including pancreatic head cancer, lower bile duct cancer, duodenal papillary cancer, lack of special pot belly cancer, etc. 2.Low malignant tumors or benign lesions that cannot be locally resected, such as endocrine tumors in the head of pancreas, cystic adenoma, pancreatic SPT, etc. 3, occupying lesions in the head of the pancreas that cannot be identified as benign or malignant, such as mass pancreatitis of the head of the pancreas. 4, Severe injury to the head of the pancreas, or duodenum. The scope of surgical resection involves 6 organs and regional lymph nodes, and after the completion of resection, it is necessary to establish the continuity between the biliary tract and the gastrointestinal tract, the pancreas and the intestine and the gastrointestinal tract itself, and at least 4 anastomoses need to be made. There is no sufficient evidence that one procedure is significantly better than the other. The specific areas of resection include: gallbladder and common bile duct; pylorus and distal gastric bulk; head of pancreas including the sulcus; all of the duodenum; about 20 cm from the beginning of the small intestine; and regional lymph nodes and fatty tissue. Complications of pancreaticoduodenectomy In addition to general surgical complications such as wound infection and abdominal bleeding, some special complications may occur in pancreaticoduodenectomy, and the incidence of complications varies from report to report, with domestic reports around 20% and foreign reports differing greatly from domestic due to different criteria for judging complications, up to 50% or more. At present, the overall surgical mortality rate of this procedure has been reduced to less than 5%. The main postoperative complications are as follows: pancreatic fistula; biliary fistula; gastrointestinal anastomotic fistula; gastrointestinal hemorrhage; gastroparesis; postoperative pancreatitis; and reflux biliary cholangitis. Effect of surgery Pancreaticoduodenectomy is the only effective method for surgical treatment of peri-potbelly cancer, but due to the biological characteristics of high malignancy of pancreatic head cancer, even if the surgery completely removes the tumor and clears the lymph nodes, there is still a high recurrence rate after surgery, and the 1-year survival rate is 10%-30%, and the 5-year survival rate is <10%, and the effect of surgery for lack of special potbelly cancer is obviously better than that of pancreatic head cancer. For low-grade malignant tumors or benign tumors in the head of pancreas, when local resection cannot be done due to anatomical factors or the requirement of radical treatment, pancreaticoduodenectomy can achieve very good results.