This paper reports a retrospective study of 51 consecutive pancreatico-duodenectomies from a Swedish university hospital concerning postoperative morbidity, number of reoperations and mortality. Resection of the distal common bile duct, duodenum, and head of the pancreas with hemigastrectomy and cholecystectomy was done in 48 patients and modified pancreaticoduodenectomy with preservation of the pylorus was done in three patients. Three patients (6%) died within 30 days. Nine patients required reoperation, three more than once. The most common major complications were anastomotic breakdown (n = 7), severe hemorrhage (n = 3) and abscess formation (n = 3). We conclude that a low postoperative morbidity and mortality can be achieved outside large, specialist centres, but the operation should be done by experienced surgeons. The results may justify carrying out the operation when the chances of cure are small, but it has yet to be evaluated as a palliative procedure.