In pancreatic cancer there is a marked discrepancy between the recorded R0 resection rates and the long-term clinical outcome. Therefore, it seems to be necessary to find additional parameters that will be of more prognostic value here. Differences in how the R classification is applied within the studies are conspicuous. It would seem important to examine standards in histopathological preparation and to return to the 'classical' R classification and, if appropriate, in line with experiences in rectum cancer, to introduce a 'circumferential resection margin'. To obtain optimum long-term survival, a distance of >1.0 mm or even >1.5 mm between tumor and resection margin is required. In too few patients with vascular invasion is the tumor properly removed surgically, even though infiltration of the portal vein or the superior mesenteric vein is not an exclusion criterion according to the S3 guideline. An improvement in the quality of treatment might be achieved by establishing 'high-volume' pancreas centers. The value of perioperative radiochemotherapy (RCT) is currently being examined in several large studies. Adjuvant chemotherapy is standard and is well established in routine clinical practice.