Pancreatic cancer is the 12th most common cancer worldwide and the 6th leading cause of cancer-related deaths, with a dismal prognosis. The median survival is 4–6 months, and the 5-year survival rate is only 12.8%. Risk factors include individual characteristics, lifestyle, environmental factors, and conditions like chronic pancreatitis and diabetes. Symptoms are often nonspecific, leading to delayed diagnosis, with 35% of patients presenting with locally advanced pancreatic cancer (LAPC) and over 50% with metastatic disease. Chemotherapy is the primary treatment for these patients, with regimen choices guided by the patient’s performance status. Surgical resection remains the only potential curative treatment for patients with resectable tumors. The Whipple procedure (pancreatoduodenectomy) is the most commonly performed surgery, involving the removal of the pancreatic head, duodenum, and other nearby structures. While this procedure offers survival benefits, it carries a mortality rate of 4–5% and a morbidity rate of 30–50%, with common complications including delayed gastric emptying, pancreatic fistulas, and bile leaks. Alternative surgical options like pylorus-sparing pancreaticoduodenectomy and distal pancreatectomy are considered based on tumor location. Currently, robot-assisted surgery is also being explored for its potential advantages in precision and recovery. Irreversible electroporation (IRE) is an emerging non-thermal treatment option for patients with LAPC, particularly after failed chemotherapy. IRE induces cell death by creating nanoscale defects in cell membranes while preserving surrounding structures. When combined with chemotherapy, IRE improves progression-free and overall survival. As surgical and interventional approaches evolve, interventional radiologists play an essential role in diagnosis, treatment planning, and managing complications in advanced pancreatic cancer.