Despite advances in modern surgery, outcomes for patients with pancreatic adenocarcinoma or periampullary adenocarcinoma remain 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 should not be banned”?Get an original essayThe aim of the work is to report our preliminary single-center experience with surgical resection plus IORT and the feasibility of IORT as a as part of management in patients with pancreatic and periampullary cancer and its effect on morbidity, mortality and local recurrence. This study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. Data were collected retrospectively. A total of six patients were included in study I between November 2013 and April 2017. All surgical procedures 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) associated with IORT. One patient had a locally advanced pancreatic tumor that was not surgically resectable. This patient underwent surgical bypass to overcome biliary obstruction associated with IORT. Two patients died due to disease progression and liver metastases and the remaining patients are alive with no evidence of recurrence at follow-up. Pancreatic adenocarcinoma is considered the 4th common cause of cancer death (1). Its 5-year survival rate is less than 5% (2). Patients with resected pancreatic adenocarcinoma have a 5-year survival rate of approximately 10% (3). Pancreaticoduodenectomy is considered the treatment of choice for resectable tumors achieving the best cure rate (3). Patients with a resectable tumor with the aim of cure at the time of presentation were low and represent only 20%. Approximately 40% of patients at presentation have their tumors beyond curative resection, however, approximately 40% of patients present with metastatic disease (4). Advances in surgical management have improved the resection rate with more favorable postoperative management accompanied by a lower rate of both surgery-related morbidity and mortality, however, this improvement has not did not have the impact of improving long-term survival (4). This has been attributed to the fact that, even if the resection appears complete, these patients typically present with advanced stages of cancer that involve inclusion of all tissue containing tumor cells in the resected specimen. This should include all draining lymph nodes and tissues around the blood vessels and neural plexus (5, 6). Histological evaluation in some studies showed that less than 15% of patients undergoing R0 resection had a pathologically negative lymph node. Additionally, positive lymph nodes were found in approximately 50% of samples and infiltration of tissues 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 recidivism rate.