Hospital volume is one of the most discussed but also disputed subjects of surgery during the recent years. In no other surgical entity as in pancreatic surgery the number of performed operations has as much influence on morbidity and mortality. Despite of decreasing mortality, morbidity in pancreatic surgery remains relatively high even in specialized centres. Numerous studies demonstrated a reduction of perioperative mortality in centres with more than 10 patients per year by over 50%. In our own collective we demonstrated a significant reduction of mortality by 4% to 1% in two successive periods and a significant reduction of morbidity from 47% to 35%. We review the factors that are held responsible for decreasing mortality and complication rate in specialized centres and review published studies on this subject up to date. Our results confirm studies form other countries that increasing centre experience as well as operations performed in high volume hospitals decrease the complication rate and mortality after pancreatic head resection.