During hepatobiliary resection, a frozen section histo­logic examination often reveals cancer involvement at the distal ductal stump. Surgical management in this setting is controversial because the biologic aggressiveness of the remnant tumor depends on its histology (i.e., invasive versus non-invasive cancer). Margin involvement with invasive can­cer signicantly reduced rate of survival [4, 33, 34]; there­fore, PD should be performed when the distal ductal margin is involved with invasive cancer, provided that the other sur­gical margins are tumor-free [35]. In contrast, several practi­cal options can be employed for the treatment of a positive distal ductal margin with non-invasive cancer because rem­nant non-invasive foci show a slow progressive nature with a mild survival impact [36]. Therefore, it works as a signicant prognostic indicator in the subset with T1-2N0 disease (early-stage disease); whereas, it does not in the subset with advanced disease or in the whole resected cohort [4, 33, 34]. Considering these ndings, the additional resection of the intrapancreatic duct alone is rst recommended [37]. When the margin is still positive after addition ductal resection, then PD should be considered unless the patient has other adverse prognostic factors representing nodal metastasis, pancreatic invasion, or vascular invasion [3, 5, 16, 38, 39].