Total pancrEaTectomy vs High-Risk Pancreatic anastomosiS

Inclusion Criteria: * Patients older than 18 years * All patients scheduled for PD for all kind of pancreatic diseases * Patients able to give their informed consent * Patients undergoing PD (Kausch-Whipple or Longmire-Traverso) * Patients presenting two major and at least one minor criteria (Major criteria: Main pancreatic duct diameter ≤3mm; Soft pancreas. Minor criteria: Bleeding stump; Friable stump; Posterior/Eccentric duct; Invisible duct; Deep pancreas; Intraoperative acute pancreatitis; FRS 9-10) * Two or more surgeons confirming eligibility * PA or TP with or without spleen preservation (Kimura technique). These techniques are consistent with clinical practice; any other procedure will be a deviation from the protocol Exclusion Criteria: * Informed consent withdrawal * Impossibility to undergo surgery for any reason * Main pancreatic duct of the pancreatic neck/body \>3mm at preoperative imaging (CT scan or MRI) * PD not performed for any reason * Absence of two major criteria * Absence of at least one minor criteria * Absence of interobserver agreement between at least 2 surgeons * More than 1 extension of resection to pancreatic neck due to pancreatic margin positivity * Wrong randomization