Surgery is the main treatment with curative intent for malignant tumours in the pancreas and the results are clearly related to the experience of the surgical team. To be able to remove the tumour with curative intent it is essential to carry out an extension study to confirm that the disease is located in the pancreas and that there is no distance affectation. Depending on the location of the tumour, radical surgical resection with the aim of total elimination must be performed. Such intervention can affect, in addition to the pancreas, other adjacent organs such as the duodenum, the distal biliary duct and the gallbladder, or the spleen, as well as requiring complex vascular resection and reconstruction. These types of interventions should be carried out in institutions with considerable experience in the treatment of these diseases. Depending on the case and the location of the pancreatic tumour in the pancreas, the surgical procedure can even be performed using a laparoscopic approach, since the results of survival are the same as in open surgery and there is significant improvement in the postoperative prognosis.

Malignant tumours of the distal biliary duct, which anatomically runs within the head of the pancreas, must be treated surgically. The procedure they require is the same as that which would have been necessary in cancer of the head of the pancreas, and consists of the resection of the pancreatic head, duodenum, bile ducts and gallbladder, as well as a complete dissection and removal of all the regional lymph nodes. In addition, there is a subsequent need for digestive tract, pancreatic and biliary reconstruction. 

With the wide use of high-resolution imaging tests, we are seeing a significant increase of pancreatic lesions diagnosed by chance. Probably, the group of pancreatic lesions which are diagnosed more frequently in this context are cystic pancreatic lesions. Knowledge about the patient's current state is essential to make a correct diagnosis as well as where necessary in the therapeutic process because a very large group of these lesions have the potential to become malignant with the passing of time. In addition, some patients with pancreatic cystic lesions requiring surgery can benefit from advanced pancreatic surgery such as enucleation or a central pancreatectomy, which is designed to treat the lesion surgically and keep the endocrine and exocrine cells in the pancreas functioning as normally as possible. 

As with patients with pancreatic cystic lesions, the incidental diagnosis of neuroendocrine tumours has experienced a noticeable increase in recent years. The origin of these tumours, unlike the malignant pancreatic tumours and the majority of the cystic lesions, are the endocrine cells present in the pancreatic gland. A small proportion of these tumours secrete hormones that can produce characteristic clinical symptoms depending on the hormone secreted and its concentration. However, most of these patients have tumours which are not associated to any hormone secretion syndrome and are therefore asymptomatic. It is essential to carry out a proper study of these patients in order to adapt the treatment plan which must monitor them through the healing process, as well as preserving the pancreatic function as much as possible. 

Patients who have a chronic inflammation of the pancreas develop a progressive replacement of normal pancreatic tissue by a fibrous and hard tissue, as well as a progressive loss of the main functions of the pancreas, in both the endocrine (regulation of blood sugar levels), and exocrine systems (facilitate the digestion process).  In some cases of advanced chronic pancreatitis, it may be complicated by the onset of pain, produced by the obstruction of the pancreatic or biliary ducts. In these cases, surgery may be necessary, consisting in the decompression of the bile or pancreatic duct, and in some cases it may even require the removal of a portion of or the entire pancreatic gland. 

The acute inflammation of the pancreas (acute pancreatitis) can lead to development of necrosis and accumulation of fluid around the pancreas, which can later become chronically encysted. When this happens, this formation is called pancreatic pseudocyst. In patients who present with this complication, it is essential to monitor and treat these lesions, if necessary, in order to prevent the occurrence of future complications. In the cases where surgery is required, the final surgical treatment consists in draining of the pseudocyst, generally in the digestive tract, in order to decompress it.

Given that pancreatic cancer can develop over a long time without producing symptoms, a high proportion of patients don't have any possibility of receiving a surgical treatment with curative intent at the time of diagnosis. In these patients, especially those with tumours located at the head of the pancreas, the progression of the disease can obstruct the bile duct and the duodenum, preventing oral alimentation. To resolve these symptons, a surgical bypass of the bile duct and the stomach can be performed with the aim of recovering the ability to eat normally.