A 21-year-old paper by Howard, "Pancreatico-Duodenectomy: Forty-one Consecutive Whipple Resections Without an Operative Mortality," inspired the analysis of 118 consecutive pancreatoduodenectomies (107 Whipple and 11 total) performed at the Surgical University Clinic Mannheim from 1985 to the present with no deaths. The surgeries were performed for 91 cases of neoplasms and 27 for complicated chronic pancreatitis. Preoperative evaluation, operative technique, and postoperative care were discussed and compared to Howard's experience. While there was general agreement on operative technique, differences existed in preoperative evaluation (modern imaging methods) and postoperative care (simplification). In this series, 21 postoperative complications required seven relaparotomies. Long-term survival after resection for carcinoma was analyzed for 133 consecutive patients with true ductal adenocarcinoma. In 76 patients with radical (R₀-) resections, the actuarial 5-year survival rate was 36%. In 44 patients with R₀-resections for pancreatic cancer more than 5 years ago, the actual survival rate was 25%. The paper is a tribute to Howard's achievement, highlighting the similarities and differences in surgical techniques and outcomes. The study emphasizes the importance of accurate preoperative evaluation, simplified postoperative care, and the role of modern imaging in improving outcomes. The results suggest that radical resections for pancreatic cancer can lead to long-term survival, although the survival rate is not high. The study also discusses the challenges of diagnosing and treating pancreatic cancer, the importance of accurate preoperative diagnosis, and the role of various diagnostic tools in improving outcomes. The paper concludes that while the early results of pancreatoduodenectomy are promising, long-term survival remains a challenge, and further research is needed to improve outcomes.A 21-year-old paper by Howard, "Pancreatico-Duodenectomy: Forty-one Consecutive Whipple Resections Without an Operative Mortality," inspired the analysis of 118 consecutive pancreatoduodenectomies (107 Whipple and 11 total) performed at the Surgical University Clinic Mannheim from 1985 to the present with no deaths. The surgeries were performed for 91 cases of neoplasms and 27 for complicated chronic pancreatitis. Preoperative evaluation, operative technique, and postoperative care were discussed and compared to Howard's experience. While there was general agreement on operative technique, differences existed in preoperative evaluation (modern imaging methods) and postoperative care (simplification). In this series, 21 postoperative complications required seven relaparotomies. Long-term survival after resection for carcinoma was analyzed for 133 consecutive patients with true ductal adenocarcinoma. In 76 patients with radical (R₀-) resections, the actuarial 5-year survival rate was 36%. In 44 patients with R₀-resections for pancreatic cancer more than 5 years ago, the actual survival rate was 25%. The paper is a tribute to Howard's achievement, highlighting the similarities and differences in surgical techniques and outcomes. The study emphasizes the importance of accurate preoperative evaluation, simplified postoperative care, and the role of modern imaging in improving outcomes. The results suggest that radical resections for pancreatic cancer can lead to long-term survival, although the survival rate is not high. The study also discusses the challenges of diagnosing and treating pancreatic cancer, the importance of accurate preoperative diagnosis, and the role of various diagnostic tools in improving outcomes. The paper concludes that while the early results of pancreatoduodenectomy are promising, long-term survival remains a challenge, and further research is needed to improve outcomes.