Schmidt et al present the problems associated with 516 consecutive patients undergoing a Whipple procedure. With a mean age of 58 years, it was found that 57% had periampullary cancers and 22% were operated on for chronic pancreatitis, 12% for cystic neoplasms, 4% for islet cell neoplasms, and 5%, other. Half of the patients had pylorus-sparing operations, and the operating time was 5 hours with 1.5 U of blood transfused. Postoperatively, complications occurred in 43% of patients including cardiopulmonary in 15% and leak or fistula formation in 9%. Perioperative mortality was 3.9% overall. Survival was high, and adjuvant therapy did not improve survival. They did demonstrate that long-term survival can be predicted by preoperative laboratory results, intraoperative factors, and pathologic characteristics. A worthwhile exercise.