Explorative laparotomy and palliative surgery keep on having the leadership, in the treatment of exocrine tumours of the pancreas, in spite of important diagnostic and surgery progress. The authors have looked at international literature and their own experience, to simplify the choice of better treatment for each patient. They compared the reliability of various diagnostic technologies and different surgery options. Metastasis and lymphatic invasion are limiting factors for surgery; the first lymphatic stage and duodenum fixation still consent curative surgery. Biliary decompression through external catheter or transpapillary endoscopic prosthesis has a primary role in the diagnostic therapeutic decision. The authors preferred to reserve gastro-jejunostomy to patients with duodenum obstruction. They choose an anterior trans-mesocolic gastro-jejunostomy with Roux-en-y reconstruction, with an upper bilio-enteroanastomosis. Pain relief is one of the most important goal in pancreas' cancer: anaesthetic and surgery techniques lead to good and long-standing results. Explorative laparotomy is often the only technique that leads to the final decision about a therapeutic plan, because it shows size, location and characteristic of the tumour and his metastasis in lymphatic and anatomic structures. The integration of metasurgery therapy (chemo-, radio-, hormono ...) allows, together with pain treatment, to improve the results above all the quality of life in carcinoma of the pancreas.
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