With the advancement of technology and the improvement of the precision of the examination equipment, the detection rate of pancreatic diseases has increased greatly. Due to the special characteristics of the structure and function of the pancreas itself, its surgical treatment is more complicated and difficult than other organ surgery, and there are many postoperative complications, so many patients will have fear. So which of these diseases require surgical treatment and which can continue to be observed, it is necessary for us to know some of them, which can better match the next step of treatment. Now I will put some of my personal views and experience with you to exchange and discuss. I. There are absolute indications for surgery: 1. Malignant diseases of the pancreas: mainly including pancreatic ductal adenocarcinoma, pancreatic alveolar cell carcinoma, pancreatic adenosquamous carcinoma, pancreatic neuroendocrine carcinoma, pancreatic metastatic carcinoma (other organ malignant diseases metastasized to the pancreas), if there is no contraindication to surgery for the above diseases, surgery is actively recommended because surgery is the only means to allow patients to survive for a long time, among which neuroendocrine carcinoma is recommended even if there is liver Surgery is also recommended for neuroendocrine carcinoma even if liver metastasis occurs, as it can prolong the patient’s survival and improve the patient’s life treatment after reducing the burden. 2. Low malignant tumors of the pancreas: including pancreatic neuroendocrine tumors (G1 or G2, functional or non-functional), pancreatic solid pseudopapillary tumors (SPT), pancreatic lymphoma, etc. Due to the low malignancy of the tumors, the prognosis of patients after surgery is better, and the survival rate of 3-5 years is much better than that of pancreatic malignant tumors. 3, pancreatic precancerous lesions: intra-pancreatic ductal mucinous papillary tumor (IPMN), mass line pancreatitis, etc. Currently, the detection rate of this type of disease is gradually increasing, according to the size and characteristics of the tumor, whether it is accompanied by elevated tumor indicators, clinicians will recommend surgical removal, early treatment can achieve curative effect. 4.Pancreatic lesions with family history: If there is a history of pancreatic cancer in your close relatives, we suggest that you should pay attention to your pancreas after the age of 40, and focus on the pancreas during the 1-2 years physical examination. If you find any occupying lesions in the pancreas, you should have timely surgery (or close follow-up), because your chance of changing pancreatic malignancy is 6-8 times higher than normal without family history. Second, further observation or recommended surgery is needed: 1. benign pancreatic diseases: including cystic occupancy of the pancreas, of which mucinous cystadenoma has a part of the malignant rate, close follow-up is recommended, if there is a significant change in the tumor within a short period of time or accompanied by abnormal increase in tumor indicators, ultrasound endoscopy or surgical treatment is recommended. If it has become malignant, it is a malignant tumor of the pancreas and must be actively operated. There are also patients with chronic pancreatitis with obvious clinical symptoms, such as abdominal pain, low back pain, etc., which affect daily life, and patients with poor results of minimally invasive treatment, surgery is recommended. Patients with pancreatic pancreatic duct stones, accompanied by clinical symptoms also need surgical treatment. 2, inflammatory lesions of the pancreas: acute necrotizing pancreatitis, if there is abdominal infection, requires surgical debridement and drainage. For pancreatic pseudocysts caused by chronic inflammation, most patients need surgery for internal drainage when the situation permits, otherwise it may be complicated by abdominal cavity infection and malignant transformation. 3. For unexplained increase in Ca19-9, we need to be alert and to conduct a comprehensive examination (including abdominal enhanced pancreatic CT, magnetic resonance, ultrasound endoscopy or PET-CT) to exclude pancreatic related diseases and try to avoid missed diagnosis and misdiagnosis. The above are some personal opinions, there are many shortcomings will gradually improve, I hope to provide some reference or help for all patients in the clinic or treatment.