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IntroductionIn locally advanced pancreatic cancer with marginal resectabiliy the question arises whether local resection potentially leading to a R1 situation is beneficial in comparison to a palliative bypass operation.Material and MethodsIn our prospective database we performed an explorative data analysis. We included 324 patients operated for pancreatic head cancer between 1995 -2008. Survival data were present for 304 patients. 151 pancreatoduodenectomies (PD) R0, 60 PD R1 and 93 single or double bypass operations (BP) were included. For statistical analysis, Spearman rank correlation and binary logistic regression of SPSS Version 15.0 were used.ResultsFor the groups R0, R1 and BP perioperative surgical morbidity (34%/32%/21%) and mortality (5%/4%/3%) were not significantly different. Median survival was 18, 14 and 6 months (p<0.05). No patient with a bypass operation survived 5 years, whereas in R0 and R1 5 yr- survival was 11% and 20%. In a subgroup analysis we found that patients receiving BP surgery in advanced stages of tumor disease (M1 or peritoneal spread) had the significantly worst prognosis and survived after surgery less than 3 months in medianConclusionsMorbidity and mortality are acceptable in either group, resection and bypass, however survival is significantly increased after resection of locally advanced tumors, even if the tumor can only be resected to an R1 status. Palliative surgical bypass yields devastating survival figures when metastasis or peritoneal carcinomatosis are present and should therefore be avoided in favour of interventional care.