Pancreatic cancer is one of the common malignancies of the gastrointestinal tract and accounts for the fourth highest number of cancer deaths in adults, with an average survival time of 4 – 6 months and a 5-year survival rate of less than 1%. At the time of diagnosis, 80% of pancreatic cancer patients are inoperable due to local progression and metastasis. Only 10 – 15% of patients can have their tumors completely removed, but even these patients have a 5-year survival rate of only 10%. In China, where pancreatic cancer incidence and mortality rates differ from most Western countries, it is the sixth leading cancer death among adults, with an overall cumulative 5-year survival rate of 1–3 percent. Pancreatic cancer, a refractory tumor, has always troubled oncologists, and the fundamental treatment principles are: surgical treatment is the mainstay in the early stage, and a combination of multiple means is the mainstay in the middle and late stage of pancreatic cancer. Surgery is the only possible radical treatment for early stage pancreatic cancer. Surgical methods include pancreatic head and duodenectomy, expanded pancreatic head and duodenectomy, pylorus-preserving pancreaticoduodenectomy, total pancreatectomy and so on. However, due to the difficulty of early diagnosis of pancreatic cancer, the surgical resection rate is low and the five-year survival rate after surgery is also low. The combination of postoperative radiotherapy can improve the five-year survival rate. For pancreatic cancer with obstructive jaundice that cannot be resected, gallbladder or bile duct jejunostomy can be chosen to reduce jaundice and improve the survival quality of patients. Stents can also be placed endoscopically to relieve the obstruction. 2. Palliative treatment of middle and advanced pancreatic cancer (1) Surgical palliative surgery: It is important for palliative treatment of pancreatic cancer. Because about 88% of patients cannot perform radical surgery due to local spread and metastasis of the tumor, when the primary tumor cannot be removed, the surgeon must decide what palliative measures to take to relieve the obstruction of the bile duct or duodenum. (1) gallbladder-jejunum loop anastomosis; (2) gallbladder-jejunum Roux-en-Y anastomosis; (3) common bile duct jejunostomy; (4) dual gastrointestinal and biliary-intestinal anastomosis. (2) Radiation therapy: pancreatic cancer is a tumor with low sensitivity to radiotherapy. Because of the deep location of the pancreas, the surrounding gastrointestinal, liver, kidney and spinal cord are less tolerant to radiation, which is unfavorable to radiation therapy for pancreatic cancer. However, in recent years, with the development of intraoperative radiotherapy and treatment planning under CT precise positioning and multifield extracorporeal radiotherapy, radiotherapy has become one of the main means in the treatment of pancreatic cancer. In postoperative and inoperable advanced pancreatic cancer, radiotherapy alone has no significant effect on the survival of patients. Combined radiotherapy and chemotherapy, on the other hand, can effectively relieve symptoms, reduce pain, improve the quality of survival, and prolong survival. In recent years, there are advocates for preoperative radiotherapy and chemotherapy to control the metastasis of tumor. (3) Chemotherapy: Chemotherapy can be administered to pancreatic cancer that cannot be removed surgically or to prevent recurrence after surgery. Chemotherapy for pancreatic cancer is expected to reduce the incidence of cancer recurrence and metastasis after surgery. (1) Single agent chemotherapy: Gemcitabine (gemcitabine): it is a difluorodeoxycytidine that, after intracellular activation, causes apoptosis by inhibiting nucleotide reductase and doping into the DNA strand to prevent its continued prolongation. It mainly acts on S-phase cells. The dose is 1000 mg/m2 (body surface area) administered intravenously over 30 min, once/week for 7 weeks with a 1-week break. Preliminary results showed that it could lead to improvement of symptoms and prolongation of survival, which deserves further study. ② Combination chemotherapy: pancreatic cancer is insensitive to chemotherapy and monotherapy is not effective. Combination chemotherapy can reduce the drug resistance of tumor and improve the efficacy. However, it is still not ideal for prolonging survival. Gemcitabine + platinum oxalate: It is the more commonly used regimen at present. (3) Local ablation therapy: ①High intensity focused ultrasound: High intensity focused ultrasound (HIFU) is to use the physical property that ultrasound can penetrate soft tissues and can be focused, and multiple beams of ultrasound generated by extracorporeal electroacoustic transducer are coupled into the body and focused in the target tissues with the help of aqueous medium, which causes ultrasound through transient high temperature effect (above 50℃), cavitation effect, mechanical effect and other mechanisms. HIFU has been effective in the comprehensive treatment of tumors, and recently, HIFU has shown its unique advantages in the treatment of pancreatic cancer. ② Radiofrequency ablation: Radiofrequency ablation (RFA) is the treatment of tumor tissue coagulation and denaturation by means of high frequency AC current and heat generated by tissue friction. Microwave ablation: Microwave ablation is the use of a probe to concentrate microwave energy in an area, causing the charged particles in tissue cells to oscillate at high speed and generate heat, resulting in a local tissue temperature of 65-100℃, which can kill tumor cells. At present, it has been successfully applied to the treatment of liver, kidney and lung tumors, and has achieved good results. For the treatment of pancreatic tumors microwave ablation is also being applied. 3.Symptomatic supportive treatment In advanced stage of pancreatic cancer, those with steatorrhea due to pancreatic exocrine insufficiency can take pancreatic enzyme preparation during meals to help digestion. For intractable abdominal pain, analgesics, including opioid analgesics, should be given; if necessary, 50%-75% ethanol should be used for abdominal plexus injection or sympathectomy. 4. Prognosis Pancreatic cancer is a highly malignant tumor with a very poor prognosis. Despite the great efforts made in the past 50 years, no significant progress has been made in improving the survival rate of pancreatic cancer. Patients with untreated pancreatic cancer have a survival period of about 4 months, those treated with bypass surgery have a survival period of about 7 months, and patients generally survive for 16 months after resection surgery. The National Institutes of Health reported that the overall 1-year survival rate for pancreatic cancer is 8%, the 5-year survival rate is 3%, and the median survival is only 2 to 3 months. Statistics from our surgical department show that the 5-year survival rate is only about 5%. Early diagnosis and early treatment is the key to improve the prognosis of pancreatic cancer, and some data show that the 5-year survival rate can be >20% if the tumor is completely eradicated early. If the tumor is confined to the head of the pancreas (≤2 cm), total pancreatectomy or Whipple surgery can have a 5-year survival rate of 15%-20%. Adjuvant therapy such as radiotherapy after surgery can improve the survival rate. For patients with adjuvant chemotherapy and radiotherapy, the 2-year survival rate can reach 40%.