Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with early detection and surgical resection being the only potentially curative treatment option. Despite advancements in diagnostics and surgical techniques, the prognosis of early-stage PDAC remains poor. Understanding the indications, approaches and perioperative management are crucial for improving patient survival. Summary: Surgical resection remains the only curative treatment for early-stage PDAC. Different surgical procedures are performed depending on tumor location and local extent. Advances in minimally invasive surgery (MIS) yielded promising results regarding postoperative recovery and oncologic outcomes. The implementation of neoadjuvant therapy has improved resection and survival rates. Still, pancreatic surgery is associated with significant morbidity. Key Messages: Surgical resection remains the only curative option for early-stage pancreatic cancer. Neoadjuvant chemotherapy plays a crucial role in improving resection and survival rates. Perioperative care has been refined by MIS, optimized surgical techniques, and structured complication management.

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