The major symptoms of periampullary neoplasia are jaun dice, lowering of weight, abdominal pain extending behind; diabetes, pancreatitis or esocrine pancreatic failure are uncommon. In the last years, surgery has been considered as the gold standard of the therapy because new technologies are able to reduce morbility and mortality. In the too advanced neo plasia, palliative surgical care permits better survival and quality of life. The duodenopancreatectomy today has a low perioperative mortality (0-3%) and an acceptable survival (15.25%). Good results were found for palliative surgery in uaresectable neoplasms while in the inoperable patients we consider endoscopic and radiological treatments better than chemiotherapy because they are able to correct the jaundice, improving quality of life (but not survival).