A diagnosis of pancreatic cancer carries a very dismal prognosis, with the 5-year survival rate being the lowest of all types of cancer. Surgical resection offers the only hope for cure in these patients. Pancreatic resectional surgery is technically demanding, and while mortality has decreased in centers of excellence, the morbidity remains significant. Numerous controversies exist regarding various aspects of complex pancreatic resections. This review attempts to address these controversies with an evidence-based perspective. We performed a literature search in MEDLINE (www.pubmed.org) with relevant key words and the corresponding MeSH terms. The search was limited to English language publications on human subjects. A manual cross-reference search of the bibliographies of relevant papers was carried out to identify publications for possible inclusion.