Pancreaticoduodenectomy （PD） is the only curative treatment for periampullary carcinomas, including the ampulla of Vater, the distal common bile duct, and the pancreas. Because positive resection margin and insufficient lymph node dissection around the superior mesenteric artery （SMA） result in a dismal outcome, we devised a new surgical technique called “total meso-pancreatoduodenum excision （tMPDe）” when
performing a PD. Between June 2009 and July 2011, 24 consecutive patients with periampullary carcinoma underwent PD with tMPDe and the surgical outcomes were evaluated. Cancer-free resection was achieved in all patients, except for one with R1 in the retropancreatic tissue. Lymph node metastasis around the SMA was found in 5 patients （21%）, while no locoregional recurrence was recognized during a median follow-up period of 18.2 months. From the results, it was found that PD performed with tMPDe is the most effective surgical-oncological treatment for patients with periampullary carcinoma.