Background: Pancreatoduodenectomy (PD) is the only cure for periampullary and pancreatic cancer. It has morbidity rates of 40–60%, with severe complications in 30%. Prediction models to predict complications are crucial. A risk model for severe complications was developed by Schroder et al. based on BMI, ASA classification and Hounsfield Units of the pancreatic body on the preoperative CT scan. These variables were independent predictors for severe complications upon internal validation. Our aim was to externally validate this model using an independent cohort of patients. Methods: A retrospective analysis was performed on 318 patients who underwent PD at our institution from 2013 to 2021. The outcome of interest was severe complications Clavien–Dindo ≥ IIIa. Model calibration, discrimination and performance were assessed. Results: A total of 308 patients were included. Patients with incomplete data were excluded. A total of 89 (28.9%) patients had severe complications. The externally validated model achieved: C-index = 0.67 (95% CI: 0.60–0.73), regression coefficient = 0.37, intercept = 0.13, Brier score = 0.25. Conclusions: The performance ability, discriminative power, and calibration of this model were acceptable. Our risk calculator can help surgeons identify high-risk patients for post-operative complications to improve shared decision-making and tailor perioperative management.

Introduction and importance: Liposarcoma is a subtype of soft tissue sarcoma. It can originate from any adipose tissue in the body. However, the most common sites are deep soft tissues of the lower extremities and retroperitoneum. Liposarcoma arising from the pancreas is extremely rare. It occasionally presents with epigastric pain and abdominal distension, yet, in most cases it is asymptomatic. It can be discovered incidentally on radiological imaging. Complete surgical excision is the only effective cure. Definitive pathological classification can be made after histopathological assessment with additional diagnostic features in biopsy material of the resected tumor. Herein, we present a case series of three consecutive adult patients with pancreatic liposarcoma who were treated surgically to increase our understanding of surgical and pathological aspects of this type of tumor. Case presentation: The first patient is a 75-year-old female with recurrence of a well differentiated liposarcoma with partial dedifferentiation in the pancreatic head who was managed surgically with pylorus-resecting pancreaticoduodenectomy (PrPD). The second patient is an 80-year-old female with pleomorphic liposarcoma of the pancreatic head who was managed surgically with the same approach. The final patient is a 72-year-old male with primary dedifferentiated liposarcoma and well-differentiated liposarcoma located dorsal to the duodenum, in close contact with the right renal fascia and with ingrowth into the pancreatic head. This patient was managed surgically with PrPD involving right nephrectomy. Clinical discussion: In this case series, we added three new cases of pancreatic liposarcoma to twenty earlier reported cases in the literature. Complete resection is not the only indicator of recurrence, recurrence can be faster in high grade tumors, such as dedifferentiated liposarcoma and pleomorphic liposarcoma. None of the patients in our study underwent (neo)-adjuvant chemo-radiotherapy. Conclusion: Surgical resection remains the curative treatment of choice for pancreatic liposarcoma. Pancreatoduodenectomy is considered safe, and it should only be performed when in line with patient physical fitness and preferences. Personalized exercise program to improve fitness is recommended in patients with low aerobic fitness. Highlights: