With more effective chemotherapy regimens and advances in surgical techniques, conversion therapy for pancreatic cancer has been proposed in recent years to improve the prognosis of patients with initially unresectable pancreatic cancer and has received widespread attention. Starting from the concept of conversion therapy, this article combines recent research progress and the authors’ experience to discuss the controversial issues in conversion therapy for pancreatic cancer, such as patient selection and evaluation, the selection of conversion regimens, surgical indications and timing of surgery, and explores the application value of conversion therapy in clinical practice, so as to provide evidence-based basis and recommendations for the treatment of patients with initially unresectable pancreatic cancer.