Pancreatic cancer remains one of the greatest challenges within oncology. Among resected patients, 5-year survival is typically only 10-25%. Among eight major randomized trials for resected pancreas cancer, five (GITSG, EORTC, ESPAC-1, RTOG 9704, and CONKO-1), containing a total of over 1,200 patients, have shaped world opinion on this subject. These trials have many significant methodological differences. Major conclusions that can be drawn from these trials in composite are (1) adjuvant chemotherapy is superior to observation following pancreaticoduodenectomy for pancreatic cancer, (2) gemcitabine is superior to 5-FU as adjuvant chemotherapy, and (3) the benefit of adjuvant chemoradiation is uncertain. Additional randomized trials are needed to address significant areas of controversy within available data. © 2007 The Society for Surgery of the Alimentary Tract.