Objective To summarize the diagnosis and treatment progress of borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) in recent years. Methods Through the retrieval of relevant literatures, the progress in the diagnosis and treatment of BR-PDAC in recent years were reviewed, to summarize the current status of definition, management, and outcome of BR-PDAC. Results Pancreatic surgery had significantly changed during the past years and resection approaches had been extended beyond standard procedures, including vascular and multivisceral resections. Consequently, BR-PDAC, which had recently been defined by the International Study Group for Pancreatic Surgery (ISGPS), had become a controversial issue with regard to its management in terms of upfront resection vs. neoadjuvant treatment and sequential resection. The key point was preoperative diagnostic accuracy to define the resectability of BR-PDAC and radical tumor resection followed by neoadjuvant treatment. Conclusion Surgery followed by neoadjuvant treatment is the only treatment option for BR-PDAC with the chance of long-term survival.