Background: Alternative fistula risk score (a-FRS) is useful to predict clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD).Methods: Clinical data from 239 patients undergoing PD were collected. The CT value of the pancreatic parenchyma was measured in the nonenhanced (N), arterial (A), portal venous (P), and late (L) phases.

is still the definitive operation to treat tumors in the pancreatic head and peri-ampullary region. Despite the decreased mortality of PD in high-volume institutions, the rate of postoperative complications remains high. [1][2][3][4][5] Postoperative pancreatic fistula (POPF) is the most common complication and the prevalence is 5%-30%. 6,7 POPF may cause serious severe secondary complications, such as post-pancreatectomy hemorrhage (PPH), intra-abdominal infection, and even death, which may lead to prolonged length of hospital stay and increased hospital costs.The International Study Group for Pancreatic Fistula (ISGPF) standardized the definition and classification of POPFs in 2005. 8 By reviewing studies for more than 10 years,