The majority of patients with pancreatic cancer are not resectable for cure at the time of presentation. Therefore, palliation of symptoms-obstructive jaundice, duodenal obstruction, and pain-are of primary importance. Obstructive jaundice is the most common presenting symptom for cancer of the pancreas and can be managed by surgical and nonoperative techniques. The decision to perform nonoperative versus surgical palliation for pancreatic cancer is influenced by the patient's symptoms, overall health status, projected survival, and the expected procedure-related morbidity and mortality. The major advantage for surgical palliation is the ability of a single procedure to combine adequate long-term palliation for all three primary symptoms of the disease. Most surgical series report acceptable hospital morbidity, mortality, and a reasonable postoperative length of stay.