Objective: This study aimed to investigate the factors associated withpancreatic fistula (PF) development after pancreaticoduodenectomy(PD) at our clinic.Methods: Patients who underwent PD for periampullarytumours between 2010 and 2019 were included in the study andcategorised into Group I (with PF) and Group II (without PF). Thedemographic and clinical characteristics, laboratory parameters,tumour characteristics and post-operative results were comparedbetween the groups. Risk factors for PF were analysed by univariateanalysis and multivariate logistic regression analysis.Results: In total, 155 patients participated in the study (GroupI: n=31; Group II: n=124). The rate of PF was 20%. The twogroups were comparable with regard to sex (p=0.348) and age(64.8 vs 66.9 years, p=0.916). Compared with Group II, GroupI had a higher number of metastatic lymph nodes (1.61 vs 0.87,p=0.041), a higher number of post-operative complications (58.1%vs 21.8%, p=0.000) and a longer duration of post-operative hospitalstay (25.25 vs 16.43 days, p=0.000). Haemoglobin (p=0.493) andalbumin (p=0.698) levels were similar between the groups. Totalsurvival duration was shorter in Group I (23.9 vs 38.18 months,p=0.024). In multivariate analyses, being ≥65 years (p=0.040),tumour localisation (p=0.021), lymph node stage (p=0.008) andtumour diameter ≥2 (p=0.021) were the independent risk factorsfor developing pancreatic fistula.Conclusion: In our study, tumour diameter, patient age and lymphnode status were associated with PF development. The developmentof PF reduced expected survival. We believe that identifying the preoperative, intraoperative and post-operative factors related to PFformation may help decrease its development.