SINCE the first successful performance by Whipple1in 1935, pancreatoduodenectomy has provided a radical means for resection of periampullary carcinomas. However, the mortality following this operation is still rather high; this is one of the major problems in treatment of these malignant tumors. Pancreatoduodenectomy usually was a staged operation in the early years of its development,1but in recent years, there has been an increasing trend toward the selection of a one-stage operation except for particular cases.2-5In an attempt at reduction of the operative mortality, since 1960 we have used a two-stage operation for highly jaundiced patients and have obtained a satisfactory result. For this reason we advocate a two-stage procedure for safer performance of pancreatoduodenectomy in highly jaundiced patients. Although the term "periampullary carcinomas" has been variously defined, it is used here to include carcinomas in or adjacent to the ampullary region and those of