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Background Pancreatic cancer remains one of the most lethal malignancies worldwide, despite advances in diagnosis and therapy. This study aims to evaluate survival outcomes of pancreatic cancer patients in Hong Kong over the past decades.Methods We conducted a retrospective cohort study of pancreatic cancer patients in Hong Kong (2000–2020) using data from the Hospital Authority Data Collaboration Lab (HADCL). Period analysis was used to calculate age-standardized relative survival. Past trends were evaluated using Joinpoint regression analysis.Results A total of 7,725 pancreatic cancer patients were included, with a median age of 68.8 years and 55.1% being male. Using period survival analysis for 2015–2020, the age-standardized 5-year relative survival rate of pancreatic cancer was estimated at 17.5% (95% CI: 15.9 to 19.1), based on 3,461 patients diagnosed between 2010 and 2020 with survival overlapping the analysis window. By sex, age-standardized 5-year relative survival rate was 16.3% (14.3 to 18.3) for males and 18.8% (16.5 to 21.2) for females. In contrast, in the period of 2005-2009, the age-standardized 5-year relative survival was estimated at 14.5% (12.3 to 16.7), based on 1,461 patients diagnosed between 2000 and 2009 who had survival in the analysis window. When stratified by sex, age-standardized 5-year relative survival rate was 14.5% (11.6 to 17.4) for males and 14.3% (11.2 to 17.4) for females. From 2005 to 2020, the age-standardized 5-year relative survival rate showed significant improving trends for the overall population (AAPC = 3.07% [1.73 to 4.08], p = 0.001) and females (AAPC = 4.87% [1.69 to 7.16], p = 0.002), but not for males (AAPC = 0.88% [-0.45 to 2.19], p = 0.160).Conclusions While improvements in pancreatic cancer survival were observed among female patients in Hong Kong, no significant progress was found for male patients. Our findings highlight both a significant survival disparity and the persistently poor prognosis of pancreatic cancer, underscoring the pressing need for enhanced early detection and more effective treatment strategies.