Abstract:  Pancreatic carcinoma has the poorest prognosis in all the digestive cancers, and the management remains challenging. Nowadays the treatment strategy of pancreatic carcinoma has been changed from “surgery first” into the mode of multi-disciplinary team (MDT) with surgery as a leading and crucial position. By historical review, some issues related to the strategy of borderline resectable pancreatic carcinoma, including value of neoadjuvant therapy, perioperative complications, laparoscopic pancreaticoduodenectomy were discussed and commentated. The breakthrough for managing pancreatic carcinoma will be based on early diagnosis and the development of biologic targeting therapy. The surgeons′ concept should constantly advance with the times, and the strategy pattern should be converted from local to system, from morphology to biology, and from surgery to oncology.