As we all know, pancreatic cancer is a highly malignant tumor of the digestive tract with insidious early symptoms and atypical clinical signs, and it is easy to metastasize at an early stage. Although surgical resection is the main method to cure pancreatic cancer, only about 20% of patients can receive surgical treatment. There are still 80% of patients with progressive pancreatic cancer and distant metastases who cannot receive surgical treatment and need further comprehensive anti-cancer treatment, which includes radiation therapy. Clinical studies have shown that radiation therapy plays a very important role in improving the prognosis of progressive pancreatic cancer. However, due to the special anatomical location of the pancreas, which is deep behind the peritoneum, and the obscuration of adjacent organs such as the liver and gastrointestinal tract around it, it is difficult to achieve the expected therapeutic effect because the external radiation for pancreatic cancer cannot be increased to an effective dose. Therefore, in order to achieve better therapeutic effect of pancreatic cancer radiotherapy, the Department of Pancreatic, Hepatobiliary Surgery of Cancer Hospital of Fudan University has pioneered the introduction of international advanced intraoperative radiotherapy technology. Intraoperative radiotherapy refers to the use of radiation to irradiate the tumor lesion in a larger dose under the condition of intraoperative direct vision. Compared with conventional external irradiation, intraoperative radiotherapy has the advantages of precision, high surface dose and less damage to normal tissues. Studies have shown that intraoperative radiotherapy for locally advanced pancreatic cancer can effectively inhibit tumor growth, prolong survival time, and have significant pain relief effect, which can significantly improve patients’ quality of life. Intraoperative radiotherapy for pancreatic cancer through conventional surgery often requires the operator to enlarge the incision and fully expose the lesion, which not only causes great trauma to the patient, but also often delays the implementation of subsequent external radiation radiotherapy and chemotherapy due to slow postoperative recovery. After a long time of exploration and research, combined with the foundation of laparoscopic work in our department for many years, we creatively introduced laparoscopic technology into intraoperative radiotherapy. After a lot of clinical practice in the early stage, our department has been able to perform laparoscopic pancreatic, liver, biliary and spleen surgeries skillfully and has accumulated a lot of clinical experience. The application of laparoscopic technology to the intraoperative radiotherapy of locally advanced pancreatic cancer has solved the problems caused by traditional intraoperative radiotherapy, such as large trauma and slow recovery. During the surgery, the surgeon only needs to make three small holes of 5-10mm in the patient’s abdomen, and then send the operating instruments and laparoscope lens into the abdominal cavity along the hole in the abdominal wall, and the laparoscope, with its function of magnification and imaging, displays the images taken inside the abdominal cavity on a special monitor through the signal processing system via optical fiber. Based on the images displayed on the screen, the surgeon uses micro-manipulation techniques to separate the organs covering the front of the pancreas, such as the stomach and colon, to fully expose the pancreas and measure the area of the lesion. After the pathology is obtained by intraoperative freezing, intraoperative radiotherapy is performed by making a 3-5 cm hole in the abdominal wall directly above the tumor, placing a light-limiting cylinder, and attaching a removable intraoperative radiotherapy device. In this way, normal tissues can be removed from the irradiation field, so that the radiation can fully cover the whole lesion area and the irradiation dose can reach sufficient effective biological dose to achieve the best effect of inhibiting tumor growth. In the past 3 years, more than 30 cases of laparoscopic intraoperative radiotherapy have been carried out in our department, and all patients have significantly improved their pain symptoms and quality of life, and at the same time, their survival period has been prolonged. Patients with progressive or advanced inoperable pancreatic cancer generally need multiple anti-tumor comprehensive treatments, including radiotherapy, interventional and Chinese medicine treatments. Traditional open intraoperative radiotherapy, due to the great trauma and slow recovery, usually requires patients to recover for more than two weeks before they can enter the next stage of radiotherapy treatment. The Department of Pancreatic Hepatobiliary Surgery of Cancer Hospital of Fudan University combines minimally invasive laparoscopic technology with intraoperative radiotherapy and adopts the new technology of laparoscopic-guided intraoperative radiotherapy, which greatly reduces the trauma of surgery and saves the operation time, and at the same time, patients can generally recover from surgery in 3~5 days so that they can receive other comprehensive treatments. This technique has gained valuable time for the comprehensive treatment of pancreatic cancer and brought new hope and good news for patients with middle and advanced pancreatic cancer, who previously accounted for nearly 80% of the total number of cases.