During the 20 odd years since its first successful execution in man, pancreatoduodenectomy has enjoyed a varying popularity in the definitive treatment of periampullary cancer. It has now been accepted as the procedure of choice for the ablation of cancers of the duodenum, including those that arise in the ampulla of Vater. For cancers arising in the head of the pancreas, however, it has never been generally employed. Many experienced surgeons in dealing with cancers of the pancreatic head have, until recently, advocated merely the establishment of a biliary-enteric shunt for the relief of jaundice, in preference to resection of the pancreas and duodenum. This pessimistic trend has been followed because of the high operative morbidity and mortality rate of pancreatoduodenectomy, because of the negligible long-term salvage of patients who survive the procedure, and because of the belief that patients live longer and more comfortably following a biliary shunt than