The article reviews the experience of a single surgeon performing 1000 consecutive pancreaticoduodenectomies from 1969 to 2003. It traces the evolution of this complex operation over five decades. The first successful regional resection of a periampullary tumor was performed by Kausch in 1909, and the operation was popularized by Whipple in 1935. However, due to high mortality rates, the operation was performed infrequently until the 1980s. As experience increased, high-volume centers emerged, leading to a significant drop in mortality. The median operative time decreased from 8.8 hours in the 1970s to 5.5 hours in the 2000s. Postoperative length of stay also decreased from 17 days to 9 days. Overall, 10 postoperative deaths occurred, resulting in a 1% mortality rate. Among 405 patients with pancreatic adenocarcinoma, 5-year survival was 18%, with higher survival rates for node-negative and margin-negative patients. The operation has become safe and effective for patients with margin-negative and node-negative tumors. The article also discusses the evolution of the procedure, including changes in surgical techniques, improved outcomes, and the role of high-volume centers in reducing mortality. It highlights the importance of high-volume surgery in improving outcomes and the potential for further improvements through neoadjuvant and adjuvant therapies. The study emphasizes the importance of experience and high-volume centers in achieving better outcomes for patients undergoing pancreaticoduodenectomy.The article reviews the experience of a single surgeon performing 1000 consecutive pancreaticoduodenectomies from 1969 to 2003. It traces the evolution of this complex operation over five decades. The first successful regional resection of a periampullary tumor was performed by Kausch in 1909, and the operation was popularized by Whipple in 1935. However, due to high mortality rates, the operation was performed infrequently until the 1980s. As experience increased, high-volume centers emerged, leading to a significant drop in mortality. The median operative time decreased from 8.8 hours in the 1970s to 5.5 hours in the 2000s. Postoperative length of stay also decreased from 17 days to 9 days. Overall, 10 postoperative deaths occurred, resulting in a 1% mortality rate. Among 405 patients with pancreatic adenocarcinoma, 5-year survival was 18%, with higher survival rates for node-negative and margin-negative patients. The operation has become safe and effective for patients with margin-negative and node-negative tumors. The article also discusses the evolution of the procedure, including changes in surgical techniques, improved outcomes, and the role of high-volume centers in reducing mortality. It highlights the importance of high-volume surgery in improving outcomes and the potential for further improvements through neoadjuvant and adjuvant therapies. The study emphasizes the importance of experience and high-volume centers in achieving better outcomes for patients undergoing pancreaticoduodenectomy.