The aim of this study was to compare palliation of patients with verified pancreatic carcinoma after radical surgery (n = 84), bypass surgery, i.e. biliary (n = 106), biliary and duodenal (n = 85), and for patients with advanced disease, i.e. laparotomy alone (n = 56), not operated (n = 106), 3 months after discharge from hospital. 128 of 233 patients (55%) still alive were followed up. Radically resected patients had the best palliation and clinical performance; on average they could perform normal activities if helped, 82% were mobile at home and 62% were pain-free. Bypassed patients can on average look after themselves but normal activities are not possible, 31% were in hospital, 26% were pain-free and 39% suffered from nausea and vomiting. Patients with advanced disease were on average incapable and required special help and care, about 70% were in hospital, 8-17% were pain-free. 'Good risk' bypassed patients, i.e. in stage I-III, used stronger analgesics (29 vs 3%) (P = 0.006) and more frequently complained of nausea and vomiting (38 vs 12%) (P = 0.02) than radically resected patients. Palliation was comparable for the two bypassed groups.