Pancreatic cancer is considered to be one of the malignancies most resistant to therapy. It is characterized by early local invasion and distant spread. Therefore, resection with curative intent is limited to a very small proportion of patients. Even in these selected patients, long-term survival remains very poor because of liver and local recurrence. Therefore, control of occult liver metastasis and local residual tumor with perioperative radiotherapy and chemotherapy may provide some palliative benefits, and should have some impact on overall survival. However, none of the studies to date are considered definitive. Japanese pancreatic surgeons have developed a number of adjuvant therapies which theoretically could be good enough to prolong long term survival, however, they have not been tested in randomized controlled trials. Planning co-operative studies on this important issue in pancreatic cancer therapy is urgently needed.