Pancreatic cancer is the fourth most common cause of death due to gastrointestinal malignancy.Despite advances in operative techniques, chemotherapy and radiation medicine, pancreaticcancer remains the gastrointestinal malignancy with the worst prognosis. Surgery is potentiallycurative for selected patients with local disease, and radiation therapy may significantly prolongsurvival in those with localized, but unresectable tumours. Pancreatic cancer is rarely cured.Improvement in the preoperative staging of pancreatic and periampullary carcinoma shouldmean fewer patients being subjected to a laparotomy without a realistic expectation of resection.Laparoscopy before laparotomy is the only reliable means of examining for the presence ofperitoneal metastases. In the absence of peritoneal deposits, ascetic fluid or peritoneal lavagefluid can be examined. Detecting scanty malignant cells amongst reactive and degenerativemesothelial cells can be difficult