**1. Introduction**

Nowadays, radical surgical treatment remains the only potentially curative treatment for patients with pancreatic cancer. Radical surgical resection followed by adjuvant chemo‐ therapy can be performed in about 20% of all pancreatic ductal adenocarcinoma (PDAC) patients by the time of diagnosis and quite often is the only chance for long‐term survival of the patients, with an average 5‐year survival of 20–25% [1, 2]. More than 80 % of them are unresectable at the moment of diagnosis due to invasion of retroperitoneal tissue, por‐ tal vein (PV)/superior mesenteric vein (SMV), invasion of mesenteric artery, presence of liver or peritoneal metastases, or inability to sustain major surgical resection. As a result of the development of surgical techniques and technologies, extended operations, including vascular resections, have become more frequently performed in specialized centers [3]. This has led to a significant change in pancreatic surgery and has enlarged the border of resectability and ensured the possibility to achieve a curative surgical approach combined with neoadjuvant and adjuvant treatment strategies in patients with pancreatic cancer. Pancreatic carcinoma is characterized with high biological activity and early involvement of retroperitoneal tissue, lymph nodes, and peripancreatic blood vessels. The majority of pancreatic cancers are diagnosed at an advanced stage. Between 30 and 35% of them are classified as unresectablebecause of the isolated involvement of superior mesenteric/portal vein (**Figure 1**) [4]. For the first time the idea for resection of the portal vein for the sake of complete removal of the tumor was presented systematically by Fortner [5]. Currently, porto‐mesenteric vein resection is a standard procedure at high‐volume pancreatic cen‐ ters. Experience in vascular surgery is indispensable for a modern pancreatic surgeon. Nowadays, only arterial resections are still a controversial issue. Nevertheless, attempts at resection involving reconstruction of the main arteries such as the coeliac axis, hepatic artery, and superior mesenteric artery (SMA) have been reported, although in small case series [6].

**Figure 1.** Resectability of pancreatic cancer patients at the time of initial diagnosis [4].
