Pylorus-preserving pancreaticoduodenectomy (PPPD) has received increasing attention as a physiological alternative to the standard pancreaticoduodenectomy (PD) in patients with adenocarcinoma of the pancreatic head or the periampullary region. We evaluated mortality, morbidity and survival in 110 patients with pancreatic carcinoma (n = 53) or periampullary carcinoma (n = 57). In each group 31 patients underwent PD, the remainder PPPD. There were no differences in age, sex and tumour stage (UICC 1987) between patients undergoing PPPD or PD. Median follow-up was 24 months. There were no significant differences in mortality and morbidity rates between procedures. The mode of resection had no influence on survival in patients with periampullary carcinoma. Patients with pancreatic carcinoma who underwent PD had a significantly better survival rate compared with those who underwent PPPD (P less than or equal to 0.05). This was particularly so in patients with stage III tumours (P = 0.007). These data suggest that in patients with ductal carcinoma of the head of the pancreas, PD provides better survival than PPPD. However, PPPD appears to achieve equivalent results to PD in patients with periampullary carcinoma.