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With nationwide centralization of PD, the in-hospital mortality rate after this procedure decreased. Further centralization of PD is likely to decrease mortality further, especially in the elderly.

Dutch Trial Registry (NTR3142).

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senior authorship. M.J.W.Zwart received funding from the Amsterdam UMC for studies on safe implementation of innovative techniques in advanced pancreatic surgery.He also received funding from the Dutch Digestive Foundation, (Maag Lever Darm Stichting), for studies on the before mentioned topics (Agreement ID: I 16-05). LAELAPS-3 received a research grant from Intuitive for funding of proctoring travel. Training suturing material was provided by ETHICON, Johnson & Johnson.