Background: Surgical resection for invasive ductal carcinoma of the pancreas is the only chance of cure, although the long-term prognosis might be poor with very few 5-year survivors. The current study aims to clarify the clinicopathologic features of actual 5-year survivors after macroscopic curative resection for invasive ductal carcinoma of the pancreas. Methods: Between January 1990 and December 2003, 242 patients, who underwent macroscopic curative pancreatectomy for invasive ductal carcinoma of the pancreas and have been observed for more than 5 years from the time of resection, were enrolled in this study. All patients were histologically confirmed as a common type of pancreatic ductal adenocarcinoma. Invasive carcinoma originating in an intraductal papillary-mucinous tumor was included, because it has been classified as a subtype of invasive ductal carcinoma and clinically treated as the same entity. Data of patients who survived more than 5 years were analyzed retrospectively, and compared with those who died within 5 years. Results: There were 45 5-year survivors (18.6%), including 10 patients (4.1%) who survived greater than ten years. The median age of the patients (25 men and 20 women) was 63 years (range, 27-80 years). The distribution of the tumor stages according to the TNM classification (UICC 6th) was as follows: stage I (n = 4: 22%), II (n =1: 6%), III (n = 5: 28%), IVA (n = 4: 22%), and IVB (n = 4: 22%). By multivariate analysis, pathological tumor category and lymph node status were the significant factor associated with 5-year survivors, with a hazard ratio (95% confidence interval) of 0.093 (0.016- 0.540: p=0.008) and of 0.218 (0.085- 0.561: p=0.002), respectively. Among the 45 5 year survivors, recurrence occurred in 9 patients (20%) from 0.4 to 5.3 years (median: 3.5 years) after operation. Seven patients died of disease from 5.0 to 7.3 (median: 5.8 years), while two patients are alive without disease 5.2 and 12.6 years after operation, respectively. Conclusions: Limited cancer extension with negative lymph node metastases significantly contributes a chance of surviving more than 5 years. However, macroscopic curative resection could provide a possibility of unpredictable long-term survivors even with advanced stage. Five years survival does not always mean a cure of disease, but all of the recurrences occurred within 5.3 years after surgical resection.