Pancreatic cancer is the fifth leading cause of cancer death in the United States, with an overall survival rate of 3%. Unfortunately, only a minority of patients present with localized disease amenable to surgical resection. Over the past 20 years, improvements in operative and perioperative management have led to a decrease in operative mortality, shorter hospital stay, and overall 5-year survival of approximately 20% in patients undergoing pancreaticoduodenectomy. Despite advances in nonoperative palliation, surgery continues to play an important role in the management of patients with locally advanced, unresectable pancreatic cancer.