Pancreatic cancer is one of the common malignant tumors of the gastrointestinal tract, accounting for the fourth most common cancer death in adults, with an average survival time of 4 – 6 months and a 5-year survival rate of less than 1%. The onset of pancreatic cancer is insidious and the cause is unknown. 80% of patients with pancreatic cancer are diagnosed and cannot be treated surgically due to local progression and metastasis. Only 10 – 15% of patients can have their tumors completely removed, but even these patients have a 5-year survival rate of only 10%. The fundamental treatment principles are: early stage pancreatic cancer – radical surgical treatment is the main treatment, and middle and late stage pancreatic cancer – multiple means of comprehensive treatment is the main treatment. 1. Early stage pancreatic cancer: surgery is the only possible radical cure. Surgical methods include pancreatic head duodenectomy, expanded pancreatic head duodenectomy, pylorus-preserving pancreaticoduodenectomy, total pancreatectomy, etc. After nearly ten years of clinical research, we have found that for patients with pancreatic cancer invading large blood vessels and losing the chance of radical surgery, preoperative high-intensity focused ultrasound treatment has significantly improved the surgical resection rate; for patients with pancreatic cancer complicated with severe obstructive jaundice, stents are placed endoscopically to relieve the obstruction first, and then high-intensity focused ultrasound treatment is given, which has significantly improved the surgical resection rate and tolerance of patients. 2. Intermediate and advanced pancreatic cancer: (1) Surgical palliative surgery: It is important for palliative treatment of pancreatic cancer. Because approximately 88% of patients cannot undergo radical surgery due to local tumor spread and metastasis, when the primary tumor cannot be resected, the surgeon must decide what palliative measures to take to relieve obstruction of the bile duct or duodenum. (1) gallbladder-jejunum loop anastomosis; (2) gallbladder-jejunum Roux-en-Y anastomosis; (3) common bile duct jejunostomy; (4) dual gastrointestinal and biliary-intestinal anastomosis. (2) Radiation therapy: pancreatic cancer is a tumor with low sensitivity to radiotherapy. Because of the deep location of the pancreas, the surrounding gastrointestinal, liver, kidney and spinal cord are less tolerant to radiation, which is unfavorable to radiation therapy for pancreatic cancer. However, in recent years, with the development of intraoperative radiotherapy and treatment planning under CT precise positioning and multifield extracorporeal radiotherapy, radiotherapy has become one of the important means in the treatment of pancreatic cancer. For postoperative and inoperable advanced pancreatic cancer, radiotherapy alone has no significant effect on the survival of patients. Combined radiotherapy and chemotherapy, on the other hand, can effectively relieve symptoms, reduce pain, improve the quality of survival, and prolong survival. In recent years, there are advocates for preoperative radiotherapy and chemotherapy to control the metastasis of tumor. (3) Chemotherapy: Chemotherapy can be administered to pancreatic cancer that cannot be removed surgically or to prevent recurrence after surgery. Chemotherapy for pancreatic cancer is expected to reduce the incidence of cancer recurrence and metastasis after surgery. (1) Single agent chemotherapy: Gemcitabine: It is a difluorodeoxycytidine that, after intracellular activation, causes apoptosis by inhibiting nucleotide reductase and doping into the DNA strand to prevent its continued prolongation. It mainly acts on S-phase cells. The dose is 1000 mg/m2 (body surface area) administered intravenously over 30 min, once/week for 7 weeks with a 1-week break. Preliminary results showed that it could lead to improvement of symptoms and prolongation of survival, which deserves further study. ② Combination chemotherapy: pancreatic cancer is insensitive to chemotherapy and monotherapy is not effective. Combination chemotherapy can reduce the resistance of tumor and improve the efficacy. However, it is still not ideal for prolonging survival. Gemcitabine + platinum oxalate: It is the more commonly used regimen at present. (3) Local ablation therapy: ①High intensity focused ultrasound: High intensity focused ultrasound (HIFU) is to use the physical property that ultrasound can penetrate soft tissues and can be focused, and multiple beams of ultrasound generated by external electroacoustic transducer are coupled into human body and focused in target tissues with the help of aqueous medium, which causes ultrasound through transient high temperature effect (above 50℃), cavitation effect, mechanical effect and other mechanisms. HIFU is less invasive, no radiation damage and no side effects caused by chemotherapy. Recently, HIFU has shown its unique advantages in the treatment of pancreatic cancer, especially in combination with surgery and chemotherapy, showing its broad application prospects. ②Radiofrequency ablation: Radiofrequency ablation (RFA) is the treatment of tumor tissue coagulation and denaturation caused by heat generated by high frequency AC current and tissue friction, which has been widely used in the treatment of liver cancer, lung cancer and other tumors, and has achieved good efficacy, but there is a risk of pancreatic leakage. Microwave ablation: Microwave ablation uses a probe to concentrate microwave energy in one area, which causes the charged particles in the tissue cells to oscillate at high speed and generate heat, resulting in a local tissue temperature of 65-100℃, thus killing the tumor cells. At present, it has been successfully applied to the treatment of liver, kidney and lung tumors, and has achieved better efficacy. For the treatment of pancreatic tumors microwave ablation is also being applied. 3.Symptomatic supportive treatment In advanced stage of pancreatic cancer, those who have steatorrhea due to pancreatic exocrine insufficiency can take pancreatic enzyme preparation during meals to help digestion. For intractable abdominal pain, analgesics, including opioid analgesics, should be given; if necessary, 50% to 75% ethanol should be used for abdominal plexus injection or sympathectomy. We found that the use of high-intensity focused ultrasound therapy can significantly improve the symptoms of intractable abdominal pain, improve their own anti-tumor immunity, and improve the quality of life with tumor survival. 4 Prognosis Pancreatic cancer is a highly malignant tumor with an extremely poor prognosis, and despite great efforts over the past 50 years, no significant progress has been made in improving the survival rate of pancreatic cancer. Patients with untreated pancreatic cancer have a survival period of about 4 months, those treated with bypass surgery have a survival period of about 7 months, and patients generally survive for 16 months after resection surgery. The National Institutes of Health reported that the overall 1-year survival rate for pancreatic cancer is 8%, the 5-year survival rate is 3%, and the median survival is only 2 to 3 months. Statistics from our surgical department show that the 5-year survival rate is only about 5%. Early diagnosis and early treatment is the key to improve the prognosis of pancreatic cancer, and some data show that the 5-year survival rate can be >20% if the tumor is completely eradicated early. If the tumor is confined to the head of the pancreas (≤2 cm), total pancreatectomy or Whipple surgery can have a 5-year survival rate of 15%-20%. Post-surgical adjuvant therapy can improve the survival rate. The 2-year survival rate can be more than 40% for patients treated with adjuvant surgery.