AbstractThis is a retrospective review of 233 patients who had surgical exploration for proven or suspected malignant lesions of the exocrine pancreas and periampullary structures. There were 24 patients with carcinoma of the ampulla or duodenum, 12 with carcinoma of the bile duct, and 197 with lesions of the pancreas. Among the latter group, 128 patients had carcinoma diagnosed at initial operation (31 by duodenopancreatectomy, 33 by liver, and 64 by other biopsies), and 69 patients had suspected carcinoma of the pancreas without histological proof. History of jaundice, pruritus, nausea/vomiting, total weight loss, duration of pain, and values of blood urea nitrogen, bilirubin, alkaline phosphatase, and albumin were significantly different among the various groups. Patients who had resection of carcinoma of the duodenum or ampulla had the best 5‐year survival rate (39 ± 12%). Among patients with resectable or nonresectable carcinoma of the pancreas, some of the symptoms and laboratory tests studied had prognostic significan