Extended lymphadenectomy has been proposed for loco-regional control of pancreatic adenocarcinoma. While retrospective series suggested a benefit, subsequent prospective trials have not shown a survival benefit. Methods to improve loco-regional control of pancreatic body/tail cancer have not been extensively investigated. Lymph node status is an important surrogate of survival but is not a driving factor for adjuvant chemotherapy. Quality improvement in pancreatic cancer surgery is discussed, focusing on the impact of lymph nodes in determining prognosis.