Pancreatic cancer is the eighth most common cancer related death in UK. 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 respectability rate reflects the advanced stage of the disease at the time of the diagnosis. At presentation, almost 50% of patients have distant spread of tumor and 35% manifest locally advanced disease. The close relationship between the pancreatic head and the superior mesenteric vessels as well as the portal vein is responsible for the larger number of patients who are left with positive margins of resection after pancreatoduodenectomy for malignant tumors of the pancreas and periampullary region and are associated with early tumor recurrence and short patient survival. Therefore, a negative resection margins represent an important goal in the surgical management of pancreatic and periampullary neoplasms. Positive margin or incomplete resection is associated with early tumor recurrence and no survival benefit compared with palliative therapy. Distant metastases constitute an absolute contraindication for resection, locally advanced disease may also preclude curative resection. Extended pancreatectomy (EP) Nowadays is similar to pancreatectomy with extended lymphadenectomy and combined resections of adjacent vessels, retroperitoneal structures and organs. A generous 2 to 3 cm segment of the SMPV confluence can be resected without the need for interposition grafting if the splenic vein is divided. In most patients who undergo SMV resection with splenic vein preservation, an interposition graft is usually required (saphenous, superficial femoral, iliac, renal, internal jugular or synthetic graft). Overall survival for patients requiring EPD is not significantly different from that of patients undergoing pancreatic resection without VR. Therefore, suspected isolated portal/mesenteric vein involvement should not be a contraindication for pancreatic resection.