Carcinoma of the pancreas is a leading cause of cancer-related death in the United States. Unfortunately, the majority of tumors are unresectable for cure at the time of presentation; therefore,palliation of symptoms to maximize quality of life is of primary importance. Surgical palliation offers the advantage of providing a single procedure that can treat or prevent all of the major symptoms: obstructive jaundice, duodenal obstruction, and pain.For most patients, optimal palliation includes hepaticojejunostomy,retrocolic gastrojejunostomy, and intraoperative chemical splanchnicectomy. Current surgical series report a low perioperative mortality rate (less than 3%) with acceptable morbidity rates. Most patients are discharged from the hospital within a short period with overall good long-term results.