Background: In colorectal surgery, so-called 'fast-track' concepts, which focus on optimal perioperative care, have shown to significantly reduce complication rates and hospital stay (Basse et al Ann Surg 2000). This study evaluates whether fast-track concepts are also safely applicable to major abdominal surgeries such as pancreatic resection. Methods and Patients: As in colorectal surgery, a fast track concept was introduced in pancreatic surgery through the application of optimized anesthetic and analgesic methods, supporting early normal gastrointestinal function and encouraging early mobilization. The perioperative data from 255 consecutive patients undergoing pancreatic resection between January and December 2004 in a high-volume center, were analyzed using univariate and multivariate models. Results: Of the 255 patients, 71% were operated for pancreatic tumors and the remaining 29 % for chronic pancreatitis. Of these patients, 180 received a pancreatic head resection, 51 a distal, 15 a total and 9 a segmental pancreatectomy. A total of 228 patients (89%) were extubated within four hours after the operation. In 80% of the cases, the nasogastric tube was removed with the extubation and clear liquids were started the first postoperative day. Patients were transferred back to the normal ward on median day 2 and showed to be fully mobile on day 3. After the first stool on median day 4, the patients were eating normal food by day 5. Finally the patients were discharged on median day 10 with a 30-day readmission rate of 4%. The mortality was 2% and medical and surgical morbidity were observed in 17% and 26%, respectively. The fast track parameters such as first stools, normal food, complete mobilization and back to normal ward correlated significantly with early discharge (p<0.05). Several factors such as younger age, low ASA score, short operation time, low intraoperative blood loss, absence of blood transfusion, type of resection, and early extubation were predictive of early discharge in the univariate analysis (p<0.05), whereas the use of epidural anesthesia and routine prokinetic medication did not influence postoperative recovery and discharge time. Age, operation time and early extubation proved in multivariate analysis to be independent factors of early discharge (Odds ratio: 4.2 and 2.8, respectively; p< 0.05). Conclusion: Fast-track concepts work also in major abdominal surgery such as pancreatic resections, leading to earlier discharge without compromising the outcome. Furthermore, the fast-track approach is feasible and safe with low re-admission, mortality and morbidity rates.