Introduction: The diagnosis of pancreatic adenocarcinoma remains a devastating life event for most patients and their families. Many patients with this relatively common malignancy present at a stage of disease not amenable to cancer-directed resectional therapy, and are treated via nonoperative palliative measures, with median survival of 4 – 8 months post-diagnosis. Conclusion: A minority of patients present with disease limited to the pancreas and periampullary region and are candidates for resectional therapy. The prognosis for these patients is determined by several factors: clinicopathologic staging, tumor biology and molecular genetics, perioperative factors and the use of postoperative adjuvant therapy.