Encouraged by the improved results of radical lymphadenectomy in patients with pancreatic carcinoma we designed and carried out a prospective study. Between Jan 88 and Jan 91, 17 patients (group A: cancer of the head of the pancreas, n = 5, periampullary cancer, n = 12) underwent a partial duodenopancreatectomy with radical lymphadenectomy, and 17 patients (group B: cancer of the head of the pancreas, n = 11), periampullary cancer, n = 6) underwent a partial duodenopancreatectomy without lymphadenectomy. Perioperative mortality was 17% (n = 3) in group A and 11.7% (n = 2) in group B. All three deaths in group A were due to erosion and hemorrhage of the completely dissected hepatic artery, and those in group B were due to pancreatitis and pneumonia, respectively. The cumulative 1-, 2- and 3-year survival rates for patients with pancreatic cancer who survived the operation were 50%, 50% and 50% for group A and 25%, 25% and 0% for group B. In patients with periampullary carcinoma 1-, 2-, and 3-year survival rates were all 47% for group A, and 100% for group B.