Abstract:Postoperative pancreatic fistula (POPF) remains a major complication affecting prognosis after pancreaticoduodenectomy (PD), closely associated with the healing of pancreaticojejunostomy. This review systematically summarizes recent advances in the key factors influencing anastomotic healing after PD from three aspects: preoperative assessment, intraoperative techniques, and postoperative management. Preoperatively, soft pancreatic texture, small main pancreatic duct, obesity, and inflammatory-nutritional markers (such as the C-reactive protein-to-albumin ratio) are identified as major risk factors. Intraoperatively, the choice of anastomotic technique should be individualized based on pancreatic characteristics, while novel suture materials, robotic assistance, and emerging biomaterials (e.g., hydrogels) show promising potential in reducing POPF risk. Postoperatively, control of bacterial colonization in drainage fluid, early drain removal, and strict glycemic management play critical roles in anastomotic healing. Future studies should focus on elucidating multifactorial synergistic mechanisms, developing dynamic predictive models, and validating new techniques and biomaterials through high-quality clinical trials to achieve precision and individualized management of POPF.