at most, improve this yield by 10%. The effect of endoscopic ultrasound, peritoneal washings, bone marrow biopsy and PET scanning have yet to be fully evaluated. It is cost-effective to limit the investigations to state-of-the-art CT scanning and accept a slightly higher rate of inoperable cases which can be managed by surgical palliation. With selection the surgical outcome should be a mortality of under 5% and a 5-year survival of 20% for duct cell carcinomas. The quality of life for patients undergoing pancreatoduodenectomy is good and their initial recovery period is no longer than 3 months before achieving an acceptable normalization of life. Adjuvant chemotherapy improves survival by 10%. Radiotherapy does not improve survival and it may even be harmful.