Many pancreatic cancers are already in the middle and late stages at the time of diagnosis, and the surgical resection rate is quite low. It is currently believed that the best outcome can only be achieved by surgical resection of the tumor, can we create the conditions for surgical resection? The use of various methods to shrink the lesion is one of the ideas, namely preoperative neoadjuvant therapy. This concept was introduced as a conceptual challenge to oncologic surgeons and medical doctors. The concept of preoperative adjuvant therapy, also known as neoadjuvant therapy, has been proposed based on the experience of postoperative adjuvant therapy, including neoadjuvant chemotherapy, neoadjuvant radiotherapy, neoadjuvant radiotherapy and preoperative focused ultrasound ablation therapy. The rationale of neoadjuvant therapy: ① Surgical removal of the primary tumor may stimulate the growth of the remaining tumor cells. ②The blood supply to the tumor surrounding tissues is somewhat changed after surgery, and some blood vessels are interrupted, atretic or narrowed, which affects the concentration and effect of chemotherapy drugs. ③The response of neoadjuvant therapy can be used to guide the prognosis of patients, and the histopathological response is positively correlated with the prognosis of patients. ④Patients may have improved disease and decreased disease stage after neoadjuvant therapy, thus achieving an improved surgical resection rate. ⑤ Neoadjuvant therapy may reduce the possibility of intraoperative dissemination. ⑤ All mid- to late-stage tumors are systemic diseases, so systemic chemotherapy can eliminate potential micrometastases and reduce the possibility of postoperative metastatic recurrence. (7) If neoadjuvant therapy is ineffective, the effect of adjuvant chemotherapy after surgery is also bound to be poor. From this perspective, neoadjuvant therapy can eliminate patients who are not suitable for surgical treatment, and it can also understand the response of tumor to treatment and determine whether patients need to continue treatment after surgery. In view of the above considerations, neoadjuvant chemotherapy plays a rather important role in the treatment of solid tumors. The concept of neoadjuvant therapy was proposed from a surgical perspective. The main purpose of chemotherapy is to improve the resection rate, i.e., to remove otherwise unresectable tumors after they have been reduced in size by chemotherapy. Unresectable and unresectable pancreatic cancer are two concepts. Unresectable” is called “unable” in English, which means that a better result can be achieved after reaching the target, but for some reasons, the target cannot be reached; “unsuitable” means unsuitable for resection, which means that a better result will not be achieved after reaching the target. Preoperative chemotherapy for pancreatic cancer is mainly aimed at those who cannot be resected at present but have the hope of resection after treatment. We refer to locally invasive lesions with significant localized involvement of important organs or structures as “locally progressive tumors. If the tumor invades the superior mesenteric artery, superior mesenteric vein or even the beginning of the portal vein, there is still a chance of resection after the lesion is reduced in size. Of course, if the tumor has extensive metastasis, it is not suitable for resection. Pre-operative chemotherapy, like normal chemotherapy, requires knowledge of the patient’s general condition, such as liver, organs, bone marrow function and the patient’s nutritional status. Another important point is to try to obtain the patient’s informed consent for better cooperation in the future diagnosis and treatment process, which is also conducive to a better outcome. The main concern of patients is the best plan, the best treatment, the best doctor, etc. In fact, there is an advertising slogan that says “there is no best, only better”. This is also true in the treatment of membrane cancer. As a poorly treated tumor, doctors, researchers and patients are all trying to find a better solution. This is why numerous clinical trial studies are being conducted internationally. Do not resent this or think it is unethical “how can you experiment on people?” On the one hand, all clinical studies have been conducted with the informed consent of the patient or guardian and the willingness of the participant to undergo such investigational treatment; on the other hand, there are studies in medical history that have been hastily banned after tens or even hundreds of years of use and found to do more harm than good, because most of the earlier studies were retrospective and sometimes did not remove some confounding factors. And nowadays, large-scale randomized controlled clinical trials are often conducted to draw real and credible conclusions, which include some volunteers, patients as well as doctors who are making their own contributions to the development of science and the recovery of patients. The main neoadjuvant treatment modalities concerning membrane adenocarcinoma include chemotherapy alone, combined with radiotherapy, and combined with focused ultrasound ablation. The latter two are the most frequent and have better results than the former. Treatment regimens are very heterogeneous, with radiotherapy doses of 50.4Gy, 40Gy, etc. according to different splits, chemotherapy drug choices such as 5-fluorouracil, calcium tetrahydrofolate, and Kenze, etc. In general, the results are similar, and there are even studies that do not consider them beneficial. In a study of 142 patients with locally resectable pancreatic cancer at MD Anderson Cancer Research Center, a leading cancer research center in the United States, the treatment regimen consisted of two: One group was treated with radiotherapy 50.4Gy/180cGy/f or 30Gy/10Gy/f before surgery followed by surgery. 5-Fu was given intravenously after surgery, and the other group first underwent surgery followed by adjuvant radiotherapy and chemotherapy. The patients were then observed for 19 months, and there was no significant difference in patient survival between the two groups. The Second Artillery General Hospital studied 22 patients with locally resectable pancreatic cancer who underwent focused ultrasound ablation prior to surgery, and their survival improved significantly. However, in view of the lack of prospective comparative studies, it is necessary to wait for the results of several clinical studies started in recent years before evaluation.