A review of 122 patients treated for pancreatic adenocarcinoma from January 1978 through December 1984 was accomplished to determine patient survival and the effect of surgical palliation. One hundred patients underwent laparotomy, including biopsy only (n = 42), biliary bypass (n = 30), gastric bypass (n = 1), biliary and gastric bypass (n = 14), and curative resection (n = 13). Total patient median survival was 3.6 months and no patient lived 5 years. No significant difference in survival was found between the biliary bypass and combined biliary-gastric bypass groups. Only 1 of 30 patients (3.3%) undergoing biliary bypass alone without evidence of pre-operative gastric outlet obstruction developed late gastric outlet obstruction requiring gastrojejunostomy. Operative time and postoperative morbidity were greater in the biliary-gastric bypass group. These results do not support routine prophylactic use of gastrojejunostomy at the time of biliary bypass for patients with unresectable carcinoma of the pancreas.