Ninety eight consecutive patients with an operative diagnosis of carcinoma of the head of the pancreas are discussed. Recent advances in the preoperative diagnosis and management appear to have failed to make a significant impact in non-specialised units, with 82 patients undergoing palliative procedures with an operative mortality of 25.6% rising to 36% when jaundice was present. Overall median survival was 202 days (range 35-967). Recurrence of jaundice developed in 42 patients and was more common with cholecysto-enteric bypass than in choledocho-enteric bypass. Forty four per cent of patients undergoing biliary bypass alone subsequently had signs of gastric outlet obstruction.
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