The pancreatic ductal adenocarcinoma (PDAC) is responsible for 95% of pancreatic malignancies. It is the 12th most common cancer and is the 7th leading cause of cancer deaths worldwide. The incidence of PDAC is increasing in the USA and in Europe (including Hungary), while mortality rate is not changing too much. The only curative therapeutic possibility is R0 surgical resection. The mortality of pancreatic resections has been decreasing in recent years and can be kept below 5% in HPB centers. The limits of surgical radicality have been extended and the en bloc resection of greater veins around the pancreas is now accepted. The survival could be improved by R0 resection of early cancers without lymph node spread and results can be augmented by combined oncologic therapies.