Surgery for Borderline Resectable Pancreatic Ductal Adenocarcinoma: Preoperative Planning, Technical Considerations, and Building a Program.

Pancreaticoduodenectomy, first described in 1935, has subsequently been refined over decades into the operation performed today for tumors of the pancreatic head and periampullary region. For years following Whipple's first publication, tumors found to be inseparable from the surrounding vasculature were considered locoregionally advanced and unresectable. Fortner began performing regional pancreatectomy with routine enbloc resection of the portal vein/superior mesenteric vein in an attempt to address high local recurrence rates and high rates of aborted operations due to vascular involvement.