56 different ampullary and periampullary lesions were treated by pancreaticoduodenal resection (PDR). There were 26 ampullary, 25 pancreatic and 5 biliary duct tumors. A retrospective pathological study of the resected specimen allowed an exact analysis of type, size and loco-regional extension of all these tumors. These data are correlated with the survival rate following an identical surgical treatment. PDR is the first choice therapy of the ampullary tumor even if lymph node involvement is present. The results of this resectional therapy are very disappointing in pancreatic and biliary duct cancers. Presence of multiple risk factors and/or lymph node involvement in these lesions preclude PDR; palliative surgery will be preferred.