A retrospective study of 76 patients undergone PTCD (included 11 cases of PTGBD) in our clinic for the past seven years was conducted to determine the efficacy of PTCD and benefits of different operative treatments. Fifty-seven patients with malignant tumor (either bile duct, pancreas head, or gallbladder cancer) were divided into three treatment groups: Group I, curative operation (9 patients); Group II, palliative operation such as internal drainage (15); and Group III, PTCD alone (33). Seventeen of 19 benign cases with PTCD were suffered from choledocholithiasis and cholangitis. Both total serum bilirubin prior to PTCD and the drainage time to attain the normal range (less than 3.0 mg/dl as serum total bilirubin level) were significantly low in the benign group compared to the malignant group (p<0.01). The survival rates in the malignancies tended to be lowered from bile duct, pancreas head, to gallbladder cancers in this order. Group I patients showed the best survival, whereas the median survival period in group II patients was 125 days which did not differ from that in group III (PTCD alone) (116 days). From these findings, the significance of adequate selection of palliative surgical treatments such as by-pass operation should be emphasized to reduce hyperbilirubinemia in the patients with unresectable malignant tumor.