BACKGROUND: Resection is the only treatment option that offers a chance for prolonged survival in patients with pancreatic ductal adenocarcinoma (1-5). Combined with improved safety of pancreatic surgery, this has resulted in resection of both the primary tumor and metastatic disease, particularly liver metastases. Simultaneously, several clinical trials with different chemotherapy regimens have been conducted, some with promising results. In this thesis recent research concerning intentional R0-resection in metastatic pancreatic cancer and chemotherapeutical advances will be presented and discussed. The focus is on overall survival, complications and quality of life (QoL). Standard palliation, such as surgical bypass and endoscopic biliary or duodenal stenting, will also be briefly adressed. METHOD: In june to august 2012 several literature searches were conducted in PubMed and UpToDate. In order to identify relevant articles published after this period, the searches were repeated in january 2014. In total, 15 main articles were included. RESULTS: Although resection of synchronous metastatic disease in pancreatic cancer can be performed with morbidity and mortality comparable to pancreaticoduodenectomy in non-metastatic disease, the surgical intervention does not seem to improve overall survival significantly. FOLFIRINOX has demonstrated a median overall survival of 11,1 months (95 % CI 9.0-13.1, P<0.001). The toxicity was increased, but still QoL imparement was reduced compared to treatment with gemcitabine. In general, palliation of symptoms caused by duodenal or biliary obstruction are best handled with stents. CONCLUSION: On general basis pancreaticoduodenectomy combined with metastasectomy cannot be recommended in pancreatic cancer patients. FOLFIRINOX is the most promising new chemotherapy regimen when it comes to survival advantage. However, it is only an alternative for a minority of patients. Further reports on toxicity are required.