Resected specimens from 41 cases of carcinoma of the head of the pancreas or the periampullary region and autopsy specimens from 16 patients with recurrence were examined for lymph node metastasis. Evidence demonstrating the need for dissection and removal of specific lymph node groups in pancreatoduodenectomy or total pancreatectomy was discussed. These include the common hepatic and celiac groups, the superior mesenteric group, the jejunal group located in the mesentery of the proximal portion of the jejunum, and the retropancreatic group located behind the uncinate process. Metastasis to these groups was found even in cases where the carcinoma was considered small. In carcinoma of the head of the pancreas, metastasis to the peripancreatic lymph nodes was seen more widely. Therefore, total pancreatectomy with lymph node dissection is desirable for this disease.