Abstract: Objective To explore the morbidity and prognostic factors of postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy (PD). Methods Clinical data about 196 consecutive patients who underwent PD in Chinese PLA General Hospital from January 1, 2013 to December 31, 2013 were recorded retrospectively. Univariate analysis and multivariate logistic regression analysis were used to estimate relative risks. Results Of the 196 patients, POPF of grade A occurred in 62 patients (31.6%), grade B in 53 patients (27.0%), grade C in 11 cases (5.6%), with a total incidence of 64.3% (126/196) and the incidence of clinically relevant POPF (CR-POPF) was 32.7% (64/196). Univariate analysis and multivariate regression analysis showed that pancreatic duct diameter and POPF rates were significantly correlated, pancreatic duct diameter≤3 mm was an independent risk factor for POPF. The CR-POPF rate was higher in patients without external pancreatic stent, furthermore, it was also an independent risk factor for CR-POPF. Conclusion POPF contributes to early postoperative morbidity and pancreatic duct diameter≤3 mm is an independent risk factor of POPF. The external drainage of pancreatic secretion with an external stent across pancreaticojejunal anastomosis can significantly reduce the mortality of CR-POPF and alleviate the severity of POPF.