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Aim:We examined the usefulness of three modified versions of POSSUM in pancreatectomy. We also explored wheter a high-risku group can be definedPatients and methods:The data of 431 consecutive patients who underwent 316 pancreatoduodenectomy and 115 distal pancreatectomy between June 1996 to December 2007 were evaluated retrospectively.The morbidity and mortality equations of Portsmouth POSSUM(P-POSSUM),elderly POSSUM(E-POSSUM),and Hiroshima POSSUM(H-POSSUM),were estimated. The subjects were divided into two groups by physiological score(PS);1)low-risk grop is less than 20 of PS,2)high-risk group is more than 21.Results:Postoperaive complications were seen in 170 cases(39.4%).Operative death within 30 days of surgery was only 4(0.9%),and 11 deaths during hospital stay(2.6%).The mean PS in the group with postoperative complication was significantly higher than that in the group without complication. The observed and expected(O/E) ratio of postoperative morbidity was 0.72(range;0.57-0.90) by original POSSUM, 0.95(range;0.50-1.28) by E-POSSUM, 0.94(range;0.68-1.17) by H-POSSUM. The O/E ratio of hospital death was 0.17(range;0-0.24) by original POSSUM, 0.61(range;0-1.50) by P-POSSUM, 0.65(range;0-1.00) by E-POSSUM, 1.00(range;0-2.00) by H-POSSUM. The morbidity and mortality in high-risk group were significantly higher than those in low-risk group.Conclusion: The E-POSSUM and H-POSSUM were better than the original POSSUM in terms of O/E ratio, an index of accuracy. We also found that a high-risk group can be defined by PS scores, which can be determined preoperatively.