Despite advances in modern surgery, the outcome for patients with pancreatic adenocarcinoma or periampullary adenocarcinoma is still poor. Recently, IORT has been introduced into the multimodal management approach to improve local control and survival. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay The aim of the work is to report our preliminary single center experience with surgical resection plus IORT and the feasibility of IORT as part of management in Patients with pancreatic and periampullary cancer and its effect on morbidity, mortality and recurrence local. This study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. The data was collected retrospectively. A total of six patients were included in study I in the period from November 2013 to April 2017. All surgeries were performed by the same surgeon. The average age was 60 years (50-71). The gender was four males and two females. Five patients underwent complete surgical resection (pancreaticoduodenectomy) combined with IORT. One patient had a locally advanced pancreatic tumor that was not surgically resectable. This patient underwent surgical bypass to overcome biliary obstruction combined with IORT. Two patients died from disease progression and liver metastases, while the remaining patients are alive with no evidence of recurrence on follow-up. Pancreatic adenocarcinoma is considered the fourth common cause of cancer death (1). It has a 5-year survival rate of less than 5% (2). Patients with resected pancreatic adenocarcinoma have a 5-year survival rate of approximately 10% (3). Pancreatic duodenectomy is considered the treatment of choice for resectable tumors achieving the best cure rate (3). Patients who had a tumor resectable for treatment at the time of presentation were few and represented only 20%. Approximately 40% of patients present with tumors beyond curative resection, however, approximately 40% of patients present with metastatic disease (4). Advances in surgical management have improved the rate of resection with more favorable postoperative management accompanied by a lower rate of both surgery-related morbidity and mortality, however, this improvement has not impacted improved long-term survival term (4). This has been attributed to the fact that although the resection appears complete, these patients usually have advanced stages of cancer resulting in the inclusion of all tissue bearing tumor cells in the resected specimen. This must include all draining lymph nodes and tissues around the blood vessels and neural plexus (5, 6). From the histological evaluation of some studies it has emerged that less than 15% of patients undergoing R0 resection have a pathologically negative lymph node. Furthermore, positive lymph nodes were found in approximately 50% of the specimens, and tissue infiltration around the pancreas including the nerve plexus was found in approximately 50% (7, 8). Multidisciplinary management including complete surgical resection with neoadjuvant chemotherapy or combined with chemoradiotherapy is considered the appropriate treatment for these patients ( 7 , 9 ). Local tumor recurrence and liver metastases are the main causes of treatment failure after surgery. The recurrence rate for resected tumors with advanced disease can range from 50 to 80% (6). This is a retrospective patient study.