Ductal pancreatic adenocarcinoma, the most frequent malignancy of the pancreas, is characterized by retroperitoneal and perineural infiltration, early formation of multiple metastases, and resistance to most of the treatment regimens currently available. Handling the aggressive growth of this disease represents a complex and challenging task for both conservative and operative medicine 1,2,3. Surgical resection, the patient's only hope for cure, offers a significantly improved prognosis, with a median survival after resection of 14–20 months and up to 25% 5-year survival rates 1,4,5. This is underlined by studies showing a distinct advantage of potentially curative (R0) versus palliative (R1/R2) surgery 1,3,5,6. Furthermore, when surgical resection was compared with radiochemotherapy for resectable pancreatic cancer, patients in the operative group fared significantly better, with a median survival of 17 months versus 11 months in the chemoradiation group 7. However, the median survival of patients with unresectable pancreatic cancer is around 4–8 months 5. The few improvements seen in these patients, especially with regard to quality of life, are primarily due to the use of gemcitabine as first-line chemotherapy 8. The standard operation for tumors of the pancreatic head is the pancreaticoduodenectomy (Whipple procedure, mostly pylorus-preserving), whereas tumors of the body or tail can be resected using a distal pancreatectomy. Adjuvant chemotherapy has also proven advantageous in terms of prolonging overall survival, whereas neoadjuvant treatment regimens and adjuvant radiochemotherapy are still considered controversial, with large randomized controlled trials (RCTs) required for further evaluation 9. Further concentration of the case load in tertiary care centers 10, which can provide experienced diagnostic and therapeutic measurements together with novel targeted therapies in a translational research approach, will hopefully further improve the outcomes of patients with this devastating disease.