Pancreatic carcinoma is an increasingly common malignancy, cure of which is rarely feasible. Ideal management involves the safe and effective palliation of symptoms once the diagnosis has been established beyond reasonable doubt and the unlikely possibility of cure by radical surgery ruled out. In this retrospective study of 173 patients, management fell short of the ideal. Histological confirmation of the diagnosis was obtained in only 42% of patients, and there was a 16% reoperation rate because of the failure of an initial palliative procedure to relieve actual or potential biliary or gastric outlet obstruction. Still more patients developed recurrent obstructive jaundice or duodenal obstruction but did not undergo further surgery. To achieve optimal palliation, it is recommended that a gastroenterostomy be performed whenever a palliative operation is undertaken for the relief of obstructive jaundice, and that biliary drainage be accomplished by anastomosis of bowel to the common hepatic duct rather than the gall‐bladder whenever possible, to minimize the risk of recurrent obstruction. It is further recommended that an attempt be made to obtain a tissue diagnosis in every case, since other methods of diagnosis are unreliabl