Background. Pancreatic head resection with segmental dudodenectomy (PHRSD) is a safe and reasonable technique appropriate for benign lesions of the head of the pancreas. Some reports have extended the indications of this technique to early stages of periampullary tumors. However, there is no evidence that an oncological operation may be performed with this procedure.Methods. To compare the perioperative factors and the degree to which regional lymph nodes were assessed, a matched-pairs analysis between PHRSD patients (n:15) and pylorus-preserving pancreaticoduodenectomy (PPPD) patients (n:15) was performed. The groups were matched with regard to age, gender and TNM classification criteria. Surgical margins evaluated included pancreatic neck, common bile duct and posterior/radial margins. The median follow-up period was 20 months for PHRSD patients and 32 months for PPPD patients.Results. The 2 procedures were comparable in regard to operation time and introperative blood loss. The lymph node groups resected en bloc included (Japanese system) for PHRSD station 17, 13, 14 and 8 for PPPD station 17, 13, 12, 14 and 8. The total number of lymph nodes examined for PHRSD was 10+2 (40% nodal involvement) and for PPPD group 17+3 (46% nodal involvement) [p<0.05]. Postoperative complications were similar in both groups except delayed gastric emptying significantly higher in PPPD group 21% compared with the PHRSD group 13% [p<0.05]. In both groups the only station of nodal involvement was 13 (posterior pancreaticoduodenal lymph node group). Ro resection was achieved in 90% of patients in both groups. One and 2 year survival was 85-80% in both groups.Conclusion. When one considers the number of lymph nodes examined as a surrogate for adequacy of surgical resection, no only PPPD but PHRSD are appropriate procedures. The lymph node group (13) is the most important site for nodal metastasis. Nodal dissection around the superior mesenteric artery is needed to improve the prognosis of carcinoma of papilla of Vater. PHRSD is an adequate option in patients with carcinoma of the papilla of Vater despite that with this procedure the hepatoduodenal ligament lymph nodes are not dissected.