Almost 90% of pancreatic tumors originate from “classic” adenocarcinoma of the exocrine ductal system of the pancreas. The incidence rate is 1/10,000, which is the fourth highest in the population in terms of tumor mortality rate. In recent years, the incidence of pancreatic cancer has been increasing year by year. Pancreatic cancer is almost asymptomatic in its early stages, with only a few non-specific symptoms. However, 90% of patients come to the doctor due to symptoms and are found to have pancreatic cancer after examination. When patients have pain, especially pain at night, about 80% of them cannot be removed surgically or have distant metastases. Only about 50% of patients with painless jaundice can undergo surgical resection, but painless jaundice is also a sign of advanced cancer in the tail of the pancreas. When pancreatic cancer is diagnosed, 40% of patients have advanced unresectable tumors and another 40% have metastases to the liver or abdomen or other sites. These advanced pancreatic? The median survival of patients is only 4-6 months, and only 10% of patients have a survival of more than 1 year after diagnosis. Less than 20% of patients can undergo radical resection of the tumor by pancreaticoduodenectomy or pancreatic tail resection. Therefore, more than 80% of the pancreatic cancer patients faced by surgeons are advanced pancreatic cancer patients. The surgical treatment of patients with advanced pancreatic cancer who cannot undergo tumor resection other than radical tumor resection is a real problem that pancreatic surgeons must face in their clinical work. There is a need to improve the quality of life and prolong the life of the patient while minimizing the patient’s pain. For the estimation of unresectable localized pancreatic tumor without distant metastasis, the pancreatic surgery group in 2005 proposed the following indications for pancreatic cancer surgery no? The indications for resection are: 1) tumor encircling several major vessels, especially superior mesenteric artery and celiac trunk and its branches; 2) tumor invading portal vein and its branches, with narrowing of the lumen for more than 5 cm or endothelial destruction; 3) occlusion of the lumen, with extensive neovascularization or portal vein spongiosis; 4) tumor with distant organ metastasis or lymph node metastasis with perivascular lymph node fusion. As for tumor size, it is not used as an independent indicator for staging assessment and resectability judgment. As we all know about the treatment of middle and late stage pancreatic cancer, despite the history of surgical treatment of pancreatic cancer mainly by surgery for more than half a century, the clinical treatment effect of pancreatic cancer has not been substantially improved. With the introduction of new chemotherapeutic agents, chemotherapeutic modalities (such as interventional and regional infusion chemotherapy) and new radiotherapy techniques, particle implantation radiotherapy and biologic therapy, a comprehensive treatment model based on surgery has been greatly emphasized. Surgical treatment of advanced pancreatic cancer has 2 therapeutic objectives: first, to improve the patient’s quality of life, to relieve biliary obstruction or gastrointestinal obstruction and to relieve the patient’s pain; second, to treat the pancreatic cancer itself and to prolong survival time. Most patients with pancreatic head cancer have biliary obstruction resulting in jaundice. Obstructive jaundice can cause abdominal discomfort, nausea and loss of appetite, and finally liver failure. In advanced pancreatic cancer, if radical resection is not possible, biliary bypass surgery is required. Bile duct bypass surgery with drainage is required for advanced pancreatic cancer that cannot be radically resected. However, it is more traumatic and takes time to heal, which will affect the schedule of chemotherapy and radiotherapy for future tumors. The first choice of treatment for biliary obstruction in patients with advanced pancreatic cancer that cannot be surgically resected is transendoscopic biliary stent placement, which is a less invasive and equally effective method of bile drainage as surgical bile-intestinal anastomosis and has the same median survival time as surgery. The choice between the more expensive self-expanding metal stent or the less expensive plastic stent should depend on the patient’s prognosis and the patient’s general condition, as well as the willingness to be placed repeatedly. The metal stent is 10 mm in diameter and is characterized by a long drainage time, with a median effective drainage time of 10 months, and obstruction caused mainly by tumor growth into the cavity. The main disadvantage of F10 plastic stent is that it is easy to be blocked by bile sludge, and the median time of drainage is 4 months, because the diameter is thin, our experience is that it is better to place 2-3 stents at a time, because bile can be drained from the gap between the stents. The bile can be drained from the gap between the stents, and the biliary stents can be replaced repeatedly. However, because the placement of stent tubes can cause poor bile drainage, which can lead to recurrent biliary infections or acute pancreatitis, the medical cost is higher than that of simple surgical biliary bypass surgery. This point should be explained to the patient before operation. When the tumor is advanced duodenal obstruction, endoscopic placement of duodenal stent, which is a self-expanding metal stent with a diameter of 16-22 mm, can also be used, and this method rarely has complications. 2. Treatment of advanced pancreatic cancer 2.1 Laparoscopic pancreatic cancer radioactive particle implantation is selected for patients with large pancreatic tumors without distant metastases and advanced pancreatic cancer with a tumor diameter greater than 4 cm, no large blood vessels or dilated pancreatic ducts passing through the central location of the tumor, and the tumor is growing in a mass. Generally, it is safer to choose the tumor in the tail of the pancreatic body because there are no important blood vessels passing through the surrounding tumor. The volume calculation on the CT film of the pancreas is needed before surgery to design the number of implanted particles. At the time of surgery, the laparoscope is inserted through the periumbilical puncture for exploration, paying attention to the presence of tumor metastases in the abdominal wall and organs. The device is then punctured and placed at the corresponding point, and the small omental sac is incised with an ultrasonic knife to expose the pancreatic tumor. Our experience is to repeatedly probe the pancreas and the tumor with a metal rod to determine the boundaries of the tumor by feel, because the texture of the tumor is very different from the normal pancreatic tissue. The radioactive particles are 125I, encapsulated in titanium alloy, and no leakage of radioactive material will occur. The half-life of radioactive particles is 60d, the diameter of internal irradiation is 1cm, and the cancer cells can be effectively killed in vivo within 0.5~1 year. It can quantitatively and directionally implant the particles inside the tumor. Particle implantation needle is 18G, and then radiation particles are implanted according to the radiation plan, usually 15~25 particles. A safe distance of 0.5 cm between the radiation particles and large blood vessels or other organs should be observed. After the implantation of the radioactive particles, abdominal drainage should be placed to prevent pancreatic leakage. The operation is relatively simple and can avoid open abdominal surgery and shorten the hospital stay, and patients can be discharged 3-4 d after the operation. Yang Guokai et al. reported the treatment of 12 cases of advanced pancreatic cancer [5], in which radioactive particles were placed intraoperatively, with an efficiency of 41.7% and a mean survival interval of 9.66 months for pancreatic cancer. The use of intraoperative ultrasound guidance with real-time ultrasound surveillance will allow for safer and more uniform placement of radioactive particles. 2.2 Laparoscopic radiofrequency ablation of pancreatic cancer Radiofrequency thermal ablation is a minimally invasive in situ tumor treatment technique that produces high temperature in the local tissue of the lesion through radiofrequency energy, drying and eventually coagulating and inactivating soft tissues and tumors.? The principle is that the electron generator produces? When radiofrequency current is applied, it causes high speed ionic vibration and friction in the surrounding tissues through electrode needles, which is then converted into heat energy and transmitted outward with time, thus causing local tissue thermal coagulation necrosis and denaturation. The present technique of radiofrequency ablation using a single electrode needle can produce foci of coagulative necrosis up to 5 cm in diameter. It can cause degenerative necrosis of large portions of pancreatic cancer. In the experimental pig pancreas radiofrequency ablation test it was confirmed that radiofrequency ablation can degenerate the intended pancreas without damage to the duodenum adjacent to the pancreas, but the damage to the common bile duct was 20%. Therefore, it is required that the scope of radiofrequency ablation should be limited to the tumor, beyond which there is a risk of damage to the common bile duct, pancreatic duct and surrounding vessels. The indications for laparoscopic radiofrequency ablation surgery are similar to those for radioactive particle implantation, which are suitable for large pancreatic tumors. for larger pancreatic tumors to avoid damage to adjacent tissues if the scope of radiofrequency ablation exceeds the tumor boundary. The operation of laparoscopic exploration and penetration is similar to particle implantation, and the key is to fully expose the pancreatic tumor. It is easier to expose the tumor in the tail of the pancreatic body, while it is more difficult to expose the tumor in the head of the pancreas because there are more blood vessels. The head of the pancreas has mesenteric vessels passing through it, so extra care should be taken when performing puncture. Intraoperative ultrasound localization of tumors is very important, but it is difficult to achieve precise localization of tumors, especially it is difficult to attempt laparoscopic ultrasound-guided puncture, and often tumors near the large vessels are not treated. The principle of treatment is to penetrate within the tumor and not to exceed the tumor boundary, which can easily cause pancreatic leakage or damage to large blood vessels. Is radiofrequency ablation and radioactive particle implantation for pancreatic cancer? How much effect does advanced pancreatic cancer have? There is a lack of bulk case comparison and long term follow up. However, according to the observation of more than 20 cases of advanced pancreatic cancer in our hospital during hospitalization after radiofrequency ablation or radioactive particle implantation, most of the patients felt a significant reduction of pain in the lower back. This may be helpful for patients with advanced pancreatic cancer that cannot be surgically resected. In conclusion, the treatment of advanced pancreatic cancer is not a single treatment by a certain method, but requires the use of several measures, such as chemotherapy, radiotherapy and biotherapy, which are expected to improve the symptoms and prolong the life of patients with advanced pancreatic cancer.