Introduction: The treatment of pancreatic cancer remains a challenge for oncologists. While malignancies of the body or tail of the pancreas are generally larger than pancreatic head lesions at the time of diagnosis, it is unknown if this location represents a worse prognosis. We hypothesized that pancreatic body or tail cancers have a poorer survival compared to pancreatic head tumors.Methods: The Surveillance, Epidemiology, and End Results (SEER) registry was used to compare patients with pancreatic head adenocarcinoma to those with body or tail cancers from 1988 through 2005. Data on patient demographics and overall survival were collected and analyzed using Kaplan-Meier method. A Cox proportional hazards model was used to study the effect of location of lesion adjusted for age at diagnosis, gender, race and year of diagnosis. The Wilcoxon Test was used to test the association between staging and lesion location in patients diagnosed in 2004 and 2005.Results: 22,293 patients with pancreatic adenocarcinoma were identified. 17096 were pancreatic head lesions with the remaining 5197 in the body or tail. The median overall survival was 6 months for all patients included. The median survival for lesions located in the head was 6 months compared to 4 months for body/tail pancreatic cancer. (p<0.0001) On multivariate analysis, body/tail lesions, older age, male gender and African-Americans were associated with poorer survival. Surgery was performed on 5374 (34%) pancreatic head lesions and 1059 (20%) body and tail lesions. Overall median survival was 13 and 11 months, respectively with no statistical difference. (p=.4637) For the years 2004 and 2005, the median overall survival for all patients was 8 months. The median survival of head lesions remained statistically different (p=0.001) from body/tail lesions for the years 2004 and 2005. For years 2004/2005, there was a significant association between stage of disease and lesion location. (p<0.0001) Approximately 60% of body/tail lesions presented at Stage IV, whereas almost 60% of head lesions presented at Stage II or less. Conclusions: While the overall survival for all pancreatic cancer is dismal, lesions in the body and tail of pancreas have a statistically poorer survival compared to head lesions. Body and tail lesions were also significantly associated with a more advanced stage of disease. With almost 60% of body/tail lesion presenting at Stage IV, pancreatic cancers of the body/tail requires careful selection of those who will benefit from surgical intervention. Neoadjuvant chemotherapy may aid in selecting those patients with favorable tumor biology.