The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. In the medical scientific hierarchy, meta-analyses and randomized controlled trials have the highest rank and their results are discussed as evidence-based medicine. We have collected all the randomized controlled trials in our clinical and research area: exocrine pancreatic cancer. We have used PubMed systematically with the key words: pancreatic cancer and randomized controlled trials, and from reading those articles we have found a few more. The present review is an attempt to make it easier for clinical pancreatologists to keep updated our knowledge about preoperative biliary stenting, techniques of pancreaticojejunostomy and extended lymphadenectomy. We also compared the results of studies concerning standard Whipple versus pylorus-preserving pancreatoduodenectomy, retrocolic or antecolic gastroenterostomy, as well as surgery versus stenting in laparoscopically unresectable pancreatic cancer.