Since July 1974, 222 cases of pancreatic cancer have been treated with a resectability of 62.2% and an operative mortality of 2.5%. We have applied combined resection of the invaded vessels (portal vein and/or hepatic artery). Pylorus-preserving pancreatico-duodenectomy by an Imanaga method is more advantageous for recovery from malnutrition, which is caused by wide dissection of the lymph nodes and nerve plexus around the aorta and SMA.