【Abstract】 Objective To multifactorially analyze the risk factors related to the post-pancreaticoduodenectomy (PD) complications and death. Methods Two hundred and thirty-three PD cases were analyzed, average age 56, of those cases, 210 malignant with 72 pancreatic head and 138 periampullary involvement, 23 benign. Fifty-nine cases suffered coexisting vital organ disorders. Results Sixty-three cases (27.0%) experienced postoperative complications, among those 58 cases (24.9%) early complications, 28(12.0%) infection, 15(6.4%) organ systemic disorder, 14(6.0%) bleeding, 12(5.2%) pancreatic fistula, 15(6.4%) reoperations, 16 postoperative death during hospitalization. The independent risk factors related to the postoperative complications included coexisting vital organ disorders, operation methods, main pancreatic duct (MPD) diameter and surgeon’s experiences, those related to the death during hospitalization included preoperative serum creatinine, coexisting vital organ disorders, surgeon’s experiences; those related to the reoperation included preoperative CA19-9, surgeon’s experiences, tumor diameters, lymph nodes metastasis; and those related to the pancreatic fistula included operation methods, MPD diameters and surgeon’s experiences. Conclusion Coexisting vital organ disorders and surgeon’s experiences are the independent risk factors related to postoperative complications and death during hospitalization, operation methods, MPD diameter and surgeon’s experiences are the independent risk factors related to the pancreatic fistula. Thus, it is very important to choose the appropriate PD candidates, select the right operation method and to familiarize the operation.