The prevalence of pancreatic cancer, which is characterized by low resection rates and dismal prognosis, is increasing with the years. Surgical resection remains the only possible radical treatment for this condition. Great progress has been achieved in surgical treatment of pancreatic cancer in recent years, as evidenced by the dramatically decreased perioperative mortality rates and incidence of postoperative complications, but the surgical resection rates and long-term results are still disappointing. The development of pancreatoduodenectomy has gone through three stages: the emergence of prototypical procedure, gradual maturity and perfection, and procedure standardization, to which, tremendous contributions have been made by a number of scholars. At present, a consensus on standardized lymphadenectomy for pancreatic cancer has been reached, and advocation of expanded lymphadenectomy for achieving a R0 resection on the basis of clinical research and the combined venous resection for improving resection rates have gained general acceptance by surgeons, but majority of them hold negative attitudes towards the combined arterial resection, with agreements on the feasibility of combined organ resection in a small number of cases with distant metastases after selection. Neoadjuvant therapy has become an intense area, but there is no consensus about the indications and detailed treatment suggestions so far. The molecular pathological classification for pancreatic cancer indicates the gain of deep understanding of this highly heterogeneous tumor, which will open a new avenue to break through the current challenges. Here, the authors overview the history and current state of surgical treatment for pancreatic cancer.