Abstract: Although the resection rate and surgical safety of pancreatic cancer has been significantly increased in recent years, however, the long-term prognosis of the patient remains dismal. In the era of multidisciplinary diagnosis and treatment, "surgery first", the traditional management strategy of pancreatic carcinoma, has been questioned and challenged because pancreatic carcinoma should be regarded as a systemic disease. For patients with locally advanced, borderline resectable or resectable tumors with high risks of recurrence, the option of "surgery last" should be advocated, which promotes systemic therapy. For patients with resectable tumors with better biological behaviors, the option of "surgery first" should be recommended.