This article reviews the outcomes of 118 consecutive pancreatoduodenectomies (107 Whipple and 11 total resections) performed at the Surgical University Clinic Mannheim from November 1985 to August 15, 1989, with no operative mortality. The study compares the preoperative evaluation, operative technique, and postoperative care to those described by Howard in his 1968 paper, "Forty-one Consecutive Whipple Resections Without an Operative Mortality." While there was general agreement on the operative technique, differences were noted in preoperative evaluation (modern imaging methods) and postoperative care (simplification). The authors report 21 postoperative complications requiring seven relaparotomies. Long-term survival after resection for carcinoma was analyzed for 133 patients, with a 5-year survival rate of 36% for radical (R0) resections and 25% for R0 resections performed more than 5 years ago. The improved early results of pancreatoduodenectomy justify its recommendation for operable patients, though long-term survival remains challenging.This article reviews the outcomes of 118 consecutive pancreatoduodenectomies (107 Whipple and 11 total resections) performed at the Surgical University Clinic Mannheim from November 1985 to August 15, 1989, with no operative mortality. The study compares the preoperative evaluation, operative technique, and postoperative care to those described by Howard in his 1968 paper, "Forty-one Consecutive Whipple Resections Without an Operative Mortality." While there was general agreement on the operative technique, differences were noted in preoperative evaluation (modern imaging methods) and postoperative care (simplification). The authors report 21 postoperative complications requiring seven relaparotomies. Long-term survival after resection for carcinoma was analyzed for 133 patients, with a 5-year survival rate of 36% for radical (R0) resections and 25% for R0 resections performed more than 5 years ago. The improved early results of pancreatoduodenectomy justify its recommendation for operable patients, though long-term survival remains challenging.