In the 1985-1994 period, 101 patients underwent resection for ductal pancreatic adenocarcinoma. In 27 patients, the resection was not associated with adjuvant therapies, whereas in 74 patients, it was. Intraoperative radiation therapy (IORT) was performed in 54 patients. Operative mortality and morbidity were similar in patients undergoing IORT (1.8 and 29.6%) to those undergoing resection alone (2.1 and 27.6%). Median survival of the IORT group was 17 vs 14 mo of the non-IORT group (irrespective of postoperative treatments) (ns); the local recurrence rates were 38 and 54%, respectively. The group of 74 patients undergoing adjuvant therapies had a greater survival than 27 patients with no adjuvant treatment, both at the univariate (p < 0.01) and the multivariate analyses (p < 0.05) (covariates tumor stage and radicality). The subgroup of patients undergoing only radiotherapy (RT) and/or chemotherapy (CT) did not show significantly better survival than patients with no additional therapies, whereas the group of patients undergoing IORT + CT + RT showed a significantly better survival (p < 0.05). In conclusion, adjuvant therapies seem to improve survival in patients undergoing resection for pancreatic cancer.