Pancreatic cancer, including ampullary, distal bile duct and pancreatic head cancer, is one of the most lethal human cancers and still is a major unsolved health problem at the start of the 21st century. It has been estimated that this disease causes 30.000 deaths per year in the USA with an incidence of 9-10 cases per 100.000 and slightly increased male: female and black: white ratios. The incidence of pancreatic cancer in the Netherlands is approximately 8.4 per 100.000 patients. This number has been quite steady over the past ten years. Pancreatic cancer currently ranks as the fifth most common cause of cancer related deaths in the western countries. Over the past 20 years the disease continuous to have an appalling prognosis with less than 1% of patients surviving more than 5 years from diagnosis, so that mortality rates and annual incidence are virtually identical.