Pancreatic cancer is an aggressive disease with an overall 5-year survival rate of less than 5%. Up to date, surgical resection represents the basis of treatment for localized pancreatic cancer and remains the only chance for cure. Due to continuous improvements in surgical techniques and perioperative care, pancreatic resections have evolved into safe surgical procedures with low mortality and acceptable morbidity rates for experienced surgeons in high-volume centers. Recently, more aggressive approaches including extended lymphadenectomy, vascular resection, surgery for metastastic or recurrent disease, and multimodal regimens have been suggested to improve long-term outcome. This article provides an overview on current standard procedures and summarizes new strategies in the surgical treatment of pancreatic cancer.