Primary pancreatic cancer is insidious in origin and most patients are already in the middle or late stage when they are diagnosed, and the surgical resection rate is less than 24%. Cancer of the head of pancreas mostly originates from the epithelium of the pancreatic duct, because the tumor grows in the head of pancreas, it can compress and obstruct the bile duct in the early stage, and the incidence of painless jaundice accounts for about 30%, thus causing patients, family members and doctors to pay high attention to it, and the chance of obtaining early diagnosis and treatment is greater; cancer of the hooked part of the head of pancreas is farther away from the abdomen, and jaundice occurs in about 15-20%. The cancer of the body and tail of the pancreas accounts for about 30%, which often originates from the alveoli, and most of them come to the doctor with persistent distension or colic in the upper abdomen and radiation to the back. Due to distant metastasis with metastasis and compression of the common bile duct or hilar lymph nodes, jaundice may also occur in advanced stages, but the chance to obtain radical surgical treatment is lost. Therefore, a thorough evaluation of the patient before surgical treatment is very important. Accurate judgment can avoid unnecessary surgical trauma, but also enable the patient to receive treatment in accordance with the principles and reasonable medical expenses. For patients with a clear diagnosis of pancreatic cancer, the first issue that specialists should consider is whether the tumor can be resected (including radical resection and palliative resection); secondly, they should choose the corresponding palliative treatment methods. We should make full use of the important role of modern imaging and endoscopic and lumpectomy techniques in this regard, and make a clearer judgment on the stage and vascular invasion of pancreatic cancer before surgery as much as possible. The objectives of surgical treatment for pancreatic cancer are: (1) to achieve radical cure through surgery; (2) to prolong the life of the patient through surgery; (3) to improve and enhance the survival quality of the patient through surgery; and (4) to relieve and reduce the pain of the patient. The choice of specific surgical treatment depends on the location of the tumor, the presence of distant metastases and obstruction of the biliary tract and digestive tract, systemic condition and comorbidities, comprehensive medical conditions and the experience and ability of the surgeon. (1) T1, T2 stage in TNM classification, no distant metastasis; (2) clear and bright fat around the abdominal trunk and superior mesenteric artery; (3) smooth portal vein of superior mesenteric vein without infiltration; (4) low density tumor and/or fat separation between normal pancreas and adjacent blood vessels; (5) patient’s general condition can withstand surgery No other medical coexisting diseases. 2. Preoperative preparation (1) early placement of nasobiliary drainage or temporary internal stent drainage for patients with obstructive jaundice, biliary decompression, and improvement of liver function; (2) correction of hydropower balance and stabilization of the body’s internal environment; (3) moderate nutritional and supportive therapy, and improvement of general condition, etc. (1) Pancreaticoduodenectomy (W hipple surgery) is suitable for pancreatic head cancer. over the past 70 years, there have been many improvements in this procedure, including the scope of resection and the way of reconstruction. The scope of resection of pancreaticoduodenectomy should usually include part of the stomach, duodenum, head of pancreas and lower bile duct; in view of the high proportion of lymphatic metastases, regional lymph node removal should be routinely added to pancreaticoduodenectomy, i.e., selective removal of lymph nodes at station 3 should be added appropriately on the basis of resection at stations 1 and 2; reconstructive surgery of the digestive tract includes distal jejunostomy of the pancreas, bile duct jejunostomy, and gastric jejunostomy. The treatment of the cut end of the pancreas includes: (1) end-to-side anastomosis between the distal pancreas and jejunum (mucosa-to-mucosa end-to-side suture); (2) end-to-side anastomosis between the distal pancreas and jejunum (including jejuno-pancreatic end socket in bundle-bond style); and (3) placement of 0.3~05 silicone tube as a stent in the pancreatic duct. (2) pancreaticoduodenectomy with preservation of the stomach and pylorus (PPPD surgery) This surgery is performed in cases with limited cancer of the head of the pancreas and has a 30-year history. Its advantages include: (1) large gastric volume, partial prevention of gastrointestinal reflux, and improvement of nutrition; (2) shorter operation time, no need to perform gastric resection, and easier duodenojejunostomy. (3) The recent effect is good, and the postoperative gastric retention can be avoided by paying attention to the protection of the crow’s claw nerve innervating the pylorus of the gastric sinus, and the gastrointestinal decompression tube can be placed for 7 days. (3) Limited pancreatectomy is mostly used for early stage pancreatic body and tail cancer. It includes splenectomy and clearance of the surrounding regional lymph nodes. (4) Total pancreatectomy The theory of multicentric pathogenesis of pancreatic cancer has attracted more and more attention in recent years. In addition to the main cancer foci located in the head of the pancreas, multiple small cancer foci can be found in other parts of the entire pancreatic tissue, and this discovery provides an important theoretical basis for total pancreatectomy. Recently, the multicenter incidence of pancreatic cancer was reported to be 19-24%, and it is believed that most recurrent cancers in the residual pancreas after pancreaticoduodenectomy are related to multiple cancer foci in the residual pancreas. Total pancreatectomy fundamentally eliminates the possibility of pancreatic leakage complications after pancreaticoduodenectomy, but there are sequelae such as diabetes mellitus and impaired digestion and absorption caused by pancreatic exocrine insufficiency, and recent studies have shown that the near and long-term outcomes of total pancreatectomy have no merit, so its indications should be strictly controlled, and it cannot replace pancreaticoduodenectomy at present. (5) Several issues should be noted ① The release of obstructive jaundice before surgery is important to improve the patient’s general condition, reduce postoperative complications, and reduce postoperative mortality. Minimally invasive endoscopic surgery (ERCP + nasobiliary drainage/temporary stent placement) can achieve immediate reduction of jaundice and can completely replace the traditional one-stage open surgery for jaundice reduction. Regardless of the type of pancreaticoduodenectomy, the order of anastomosis arrangement in reconstructive surgery should be pancreaticojejunostomy first, followed by bile duct jejunostomy and gastrojejunostomy second, and the distance between pancreatic and bile duct jejunostomy and gastrojejunostomy should be more than 30 cm to avoid the upstream infection of pancreatic and bile duct. (iii) Extensive retroperitoneal lymph node dissection as part of pancreaticoduodenectomy remains controversial. There is no evidence-based medical evidence to show that extensive retroperitoneal lymph node dissection in addition to standard pancreaticoduodenectomy improves survival; therefore, regional lymph node dissection is not a routine part of pancreaticoduodenectomy. Therefore, regional lymph node dissection is not a routine part of pancreaticoduodenectomy. ④ With the development of extended radical resection for pancreatic cancer, tumor involvement of portal vein and extensive regional lymph node metastasis are no longer contraindicated for surgical resection, but the arbitrary extension of resection must be validated by long-term survival and concluded by prospective controlled clinical trials. There is a lack of reports of multicenter, large sample, double-blind trials in clinical practice. Surgical palliative surgery for intermediate and advanced pancreatic cancer 1. Palliative pancreaticoduodenectomy The surgical resection rate of pancreatic head cancer is only 10-20%, and the 5-year survival rate after surgery is 5%, but those who obtain long-term survival are all cases after surgical resection. Especially in the last decade, with the advancement of surgical techniques and perioperative management, the mortality rate of whipple surgery has been reduced to less than 3% in large comprehensive medical centers, therefore, patients with pancreatic head cancer should strive for surgical resection when conditions permit. Regarding the surgical approach, most data show that either reduced pancreaticoduodenectomy (such as whipple surgery with preservation of the pylorus) or expanded pancreaticoduodenectomy (combined with vascular resection and reconstruction, extensive retroperitoneal lymph node removal and soft tissue resection, total pancreatectomy, etc.) did not improve the long-term survival rate of patients with pancreatic cancer, therefore, reasonable radical surgery for pancreatic cancer is currently advocated, and the indications for surgery should be mastered Therefore, we now advocate reasonable radical pancreatic cancer surgery, mastering the indications for surgery and paying attention to the quality of surgery. Regarding palliative pancreaticoduodenectomy, some data show that the one-year survival rate after surgery is higher than that of palliative double bypass surgery, and that perioperative complications and mortality do not increase, but only the length of hospital stay increases. However, it should be noted that pancreaticoduodenectomy is a very traumatic procedure, and its indications and possibilities should be carefully considered. The diagnosis cannot be made by visual observation alone but must be made by pathological examination. If the infiltrating and metastatic lesions of the cancer are beyond the scope of radical surgery, even forced resection will not improve the long-term survival rate. Palliative pancreaticoduodenectomy, there is not enough evidence that it should be used routinely. 2, palliative double bypass surgery Most people currently advocate the use of bile duct jejunostomy rouxy anastomosis to relieve biliary obstruction with additional gastrojejunostomy to relieve or prevent duodenal obstruction. In the past, abdominal pain and pancreatic endocrine dysfunction caused by pancreatic duct obstruction were often neglected. In recent years, in some patients with significant pancreatic duct obstruction, additional pancreatic duct jejunostomy was performed along with bile duct and gastrointestinal anastomosis, which solved the pain caused by pancreatic duct hypertension without increasing surgical complications and improved the pancreatic exocrine dysfunction. 3.Laparoscopic palliative double bypass surgery With the development of laparoscopic minimally invasive surgery, laparoscopic bile-intestinal anastomosis and gastrointestinal anastomosis have been increasingly used to solve the symptoms of jaundice and duodenal obstruction in patients with pancreatic head cancer, which have the advantages of less trauma, faster recovery and shorter hospitalization time. 4.Endoscopic stent placement surgery, especially in recent years, the rapid development of endoscopic surgery technology, new materials and new technology, through the endoscopic placement of biliary stents, pancreatic duct stents and intestinal stents, lifting biliary and pancreatic duct obstruction, restoring the normal physiological channel and function of the digestive tract, can make the patient’s general condition improve rapidly in a short time, at least 6 months, the longest reported is 19 months. The procedure can also be repeated, which greatly reduces the patient’s pain due to open surgery, improves the quality of life and prolongs the survival period. At the same time, it expands and extends the treatment window and provides a therapeutic access for the comprehensive treatment (radiotherapy, chemotherapy, local radioion placement) of patients with advanced pancreatic cancer. It provides another more humane option for the treatment of advanced pancreatic cancer, and is an effective alternative to open palliative surgery.