The introduction of new efcacious chemotherapy regimens (FOLFIRINOX) along with the extensive experience in venous resection for borderline pancreatic tumors has led to the development of extended pancreatic resection for locally advanced malignancy [1–4]. In these procedures the arterial vessels of the coeliac and superior mesenteric axes are resected and reconstructed simultaneously with pancreatec­tomy in order to achieve local control for locally advanced pancreatic malignancy. Pancreatectomies with arterial resec­tions were initially characterized by high postoperative mor­tality and poor long-term survival as reported by Fortner etal. and then abandoned [5, 6]. The establishment of high volume center for pancreatic resection along with experience in vascular resection during HPB surgery and liver and pan­creas transplant let some centers to revisit these procedures for patients with locally advanced disease [7–10]. The expe­rience needed for performing such complex resections goes beyond pancreatic surgery alone and entails skills in vascular surgery which can need a multidisciplinary approach includ­ing eventually vascular surgeons. Reconstructing arterial vessels might need autologous and/or heterologous vascular substitutes which should be available immediately. For these reasons accurate preoperative planning and simulation on the basis of cross-sectional imaging should be the rule when planning these procedures. The occurrence of pancreatic leak into the postoperative period could be very often a lethal event by causing erosion and thrombosis of reconstructed vessels and consequent death. These highlights such as arte­rial resections should be reserved to very high volume cen­ters to surgeons well beyond their learning curve with standard pancreatic resections [8]. Arterial resections are now gradually centralized in very high volume centers and as a matter of fact the largest series of arterial resection are now reported by few European, American and Asian centers [4,