As we have a deeper and more thorough understanding of the biological behavior of pancreatic head cancer, surgical treatment concepts of this lethal disease are changing all the time. Meanwhile, numerous arguments emerge. Thus, we will probe into the focuses and arguments in the surgical treatment of pancreatic head cancer in this article, including the scope of lymphadenectomy, total mesopancreas excision (TMpE), vascular resection, minimally invasive pancreaticoduodenectomy (PD), palliative resection, surgery for recurrent disease and surgery for primary pancreatic cancer and liver metastasis.