The poor prognosis in pancreatic carcinoma has been increased especially by improved diagnostic procedures and decreasing perioperative mortality. Median survival after complete resection is commonly less than 20 months and the 5 years survival is in the range of about 20%. Postoperative radiochemotherapy reduces the local recurrence rate but not the overall survival however. Pancreatic carcinoma is characterized by a low chemosensitivity of the drugs commonly used like 5-FU. More aggressive chemotherapy protocols are limited by the reduced status of the patient. Multimodal and prolonged adjuvant schedules did not show a prognostic benefit. The current ESPAC--study investigates the role of simultaneous radiotherapy and 5-FU alone or in combination with neoadjuvant 5-FU and folic acid for 6 months. New protocols will investigate the value of regional adjuvant chemotherapy ESPAC 2) [44] and of gemcitabine, 5-FU or control in a three arm study.--In a multicenter German trial the benefit of gemcitabene as weekly monotherapy for 6 months is investigated. The treatment starts soon after resection due to low toxicity and good patient compliance.