The most frequent tumor of the pancreas is the ductal adenocarcinoma (PDAC). Still, total resection of the pancreatic tumor is the only curative treatment option. Most of the tumors are located in the pancreatic head. Thus, pancreatoduodenectomy (WHIPPLE/PPPD) is the oncological standard procedure. By concentrating pancreatic resections in specialized centers for pancreatic surgery perioperative mortality and morbidity has decreased over the last years. However, pancreatic resections remain complex and difficult operations; in particular the pancreatic anastomosis is challenging. Furthermore, resections of venous vessels are often necessary. In a few cases arterial resections could be considered to reach complete RO resection. Today, adjuvant chemotherapy after total tumor resection is standard in advanced tumor stages; lately, neoadjuvant regimes have been increasingly reported.