Abstract: Pancreatic carcinoma is still a challenging disease, although the resection rate and the operative safety have been improved, the prognosis of the patients is dismal. Now the therapy strategy is changed from “surgery first” into the mode of multidisciplinary team(MDT). Surgical resection is the only curable therapy for pancreatic carcinoma. Recently, the clinical role of extent of lymphadenectomy, combined vascular resection, and total mesopancreas excision was recognized more deeply. If “1 mm rule” is applied to define the resection margin, most pancreatic cancer resections are R1 resections, which benefit the patients. There has been consensus on the definition of peri operative complications. Neoadjuvant therapy is advocated for patients with borderline resectable pancreatic carcinoma.