Adenocarcinoma of the pancreas is one of the commonest gastrointestinal tumors, with 37 000 new cases predicted in the USA in 2007 . It is also one of the deadliest with over 33 000 deaths predicted in 2007. In fact, although carcinoma of the pancreas is well down on the list of cancer sites in terms of incidence, it is the fourth most common cause of all cancer deaths in both males and females . Surgery offers the only hope for cure, but in most cases the extent of the disease at presentation is such that resection is not possible. In the past 25 years some aspects of surgical treatment have improved dramatically. Surgical mortality rates have fallen from 15–20% to 1–2% in high volume centers , and morbidity rates, especially pancreatic fistula rates, have also fallen recently . There is also evidence that long-term survival is improving, as the gap between the incidence of the disease and the mortality rate is widening annually . Adenocarcinoma may arise throughout the gland but is more common in the head of the pancreas. The diagnosis and management issues facing the surgeon when dealing with cancer of the head differ from those associated with cancer of the body and tail of the gland, and we will deal with these sites separately.