Pancreatic adenocarcinoma has poor prognosis and low resectability rates. Although surgical resection remains the only potential curative treatment for adenocarcinoma of the pancreas, only 10% to 20% of all patients are candidates for pancreatic resection. This low resectability rate reflects the advanced stage of the disease at the time of diagnosis. At presentation, almost 50% of patients have distant spread of the tumor and 35% manifest locally advanced disease. Vascular invasion by the tumor constitutes a large portion of this group in which the mesenteric vessels and portal vein are usually involved. Portal and mesenteric vein involvement can be detected whether during preoperative staging or intraoperatively. As a trial to improve the resectability and probably the outcome of these patients, portal vein resection and subsequent reconstruction together with pancreaticoduodenectomy could be performed in patients with cancer head of the pancreas in this study. The method of reconstruction was either by the use of a saphenous vein patch, saphenous vein interposition graft or the use of superficial femoral vein. The effect of different factors as demographic data, operative factors, tumor factors and types of grafts on morbidity and mortality were studied. Thus, the involvement of portal/superior mesenteric vein can be considered not to be a contraindication to resection. Pancreaticoduodenectomy with excision and reconstruction of the portal vein offers free surgical margins of resection and can be facilitated by some technical steps during the procedure.