Abstract: Pancreatic carcinoma has the poorest prognosis in all the digestive cancers, and the management is still challenging. In recent years, the rapid development of surgical technique has led to the increase in the resection rate and the significant decrease in perioperative mortality and morbidity. However, the prognosis of pancreatic carcinoma has not been improved. Nowadays, the treatment strategy of pancreatic carcinoma has been changed from “surgery first” into the mode of multidisciplinary team. If “1 mm rule” was used as the standard protocol for assessment of resection margins, most of the pancreatic resection were therefore R₁ resections. Neoadjuvant therapy is advocated for patients who meet specific characteristics. Under the guidance of the concept of precision medicine, surgical treatment of pancreatic carcinoma should be changed from the modes of morphology and surgery to the modes biology and oncology.