1. There is a lack of evidence on the need to perform portal/superior mesenteric vein (PV/SMV) resection routinely in pancreatic ductal adenocarcinoma (PDAC) patients with venous involvement who responded to neoadjuvant treatment (NAT).
2. There is no significant differences in R0 rate, 5-year overall survival and recurrence-free survival between the PV/SMV preservation (PVP) group and PV/SMV resection (PVR) group.
3. PVP group showed significantly better 5-year PV/SMV stenosis free survival than the PVR group.
4. We propose that if dissection is possible and there is a high likelihood of achieving R0 resection after NAT, routine PVR may be unnecessary in PDAC patients with venous involvement.

Inclusion Criteria:

• Pancreatic head cancer patients who underwent surgery after neoadjuvant treatment between January 2012 and December 2022 at Seoul National University Hospital

Exclusion Criteria:

• Metastatic unresectable and locally advanced pancreatic cancer
• Resectable pancreatic cancer without portal/superior mesenteric vein invasion
• Cancer aggravation after neoadjuvant treatment
• Portal/superior mesenteric vein encasing and narrowing after neoadjuvant treatment
• Patients who underwent palliative surgery
• Non-pancreatic ductal adenocarcinoma patients
• Patients who death within 30 days of surgery
• Loss of follow-up patients
• Patients who underwent resection for suspected main artery and adjacent organ invasion

This study retrospectively included 264 pancreatic head cancer patients who underwent surgery after neoadjuvant treatment between January 2012 and December 2022 at Seoul National University Hospital in Korea. Among 264 patients, we included 113 patients with resectable and borderline resectable pancreatic ductal adenocarcinoma with venous involvement who responded to NAT and underwent curative PD.