Since July 1974, 210 patients with cancer of the pancreatic head have been treated with a resectability rate of 65.7% (138/210) and an operative mortality of 2.9% (4/138). Combined resection of invaded vessels (portal vein and/or hepatic artery) have been applied. The 3- and 5-year survival rate for all resected patients were 21.8% and 18.0%, respectively. Reconstruction by an Imanaga method provides better postoperative nutritional status and enables endoscopic examination of pancreatic and biliary enteric anastomoses.