|Pancreatic cancer is a lethal disease. In many parts of the world the incidence and death rate from this disease is still rising. The two main operations performed for pancreatic cancer are distal pancreatectomy with splenectomy and pancreaticoduodenectomy. Resection of periampullary malignancies were first championed by surgeons such as Halsted, Kausch, and Whipple. This operation was not done frequently after its introduction until the last few decades when the operative mortality has been significantly reduced. There have been numerous studies that demonstrate the correlation between volume of pancreatectomy at a hospital with operative mortality, as well as other outcome measures. To further improve our results with pancreatic cancer we need to a) better understand the genetic and molecular defects, b) focus on prevention, c) detect it at an earlier stage, d) develop more effective systemic therapies, e) convert more patients to resectable, and f) give state of the art multidisciplinary care. We also need to define the role of the laparoscopic or robotic pancreatic resection.