Hospital volume and surgeon’s case load have been intensively discussed as predictors for perioperative mortality after pancreatic resection. Few data are known regarding perioperative data of a single surgeon in two different hospital settings. We, therefore, analyzed data after pancreatic head resections (PHR) performed by a high-volume pancreatic surgeon in a high volume university hospital and in a community hospital with low prior experience with pancreatic resections. Methods: The perioperative outcome data after PHR performed by a single surgeon were evaluated. In 11/2006 this surgeon changed from a University department specialized in pancreatic surgery (DeptA; personal caseload for pancreatic resections 11/2006 > 300 PHR) to a community hospital with almost no institutional experience with pancreatic resections (DeptB) and initiated a new pancreatic surgery program. In DeptB 58 elective PHR were then performed from 11/2006 to 10/2008. We compared the perioperative outcomes of those 58 patients with the outcome of the last 58 patients undergoing PHR by this surgeon in DeptA. The same surgical and perioperative techniques were applied in both series (anastomosis, abdominal drains, no octreotide prophylaxis, early enteral feeding, retrocolic pylorojejunostomy in PPPD). The data of both series were prospectively recorded in (identical) SPSS-databases. Results: The median age of the patients was lower in DeptA (63 years vs. 68 years in DeptB; p<0.01). Indications for PHR were (DeptA/DeptB) pancreatic or periampullary cancer (64%/62%), chronic pancreatitis (26%/19%) and various others (10%/19%). Types of surgery performed were a PPPD in 72%/74%, classical Whipple in 9% each, duodenum-preserving PHR in 14%/10% and total pancreatectomy in 5%/7%. Superior mesenteric-portal vein resections were performed in 19%/17% of the cases (in 27%/26% of malignancy as indication). Median duration of surgery was comparable (415 vs. 390 mins; n.s.). Mortality rate was 1/58 (1.7%) in DeptA and 2/58 (3.4%) in DeptB (n.s.). Complication rates were (DeptA/DeptB): 48%/38% (any complication), 22%/24% (surgical complication) and 7%/12% (pancreatic leak grade B or C), all not significantly different. Reoperation rate was 7% in each series. Conclusions: Ensuring a sufficient caseload an experienced pancreatic surgeon can establish a new program in a hospital with low prior experience in PHR without increasing morbidity and mortality. The results could be achieved despite acceptance of locally advanced tumors (i. e. rate of vein resection) and elderly patients for resection.