Most pancreatoduodenectomy (PD) procedures for locally advanced pancreatic head adenocarcinoma (PDAC) require superior mesenteric/portal vein (SMV/PV) axis resection and reconstruction. Here we describe the inverted Y‐shaped as a new technique for complex SMV/PV reconstruction and aimed at evaluating its safety and effectiveness. Among 287 patients who underwent PD for locally advanced PDAC from April, 2007 to December, 2020 at our hospital, 11 patients (3.8%) who underwent PV/SMV reconstruction with this technique were enrolled. Briefly, two distal veins were slit‐wedged, sutured, resulting in one orifice, then reconstruction was completed with (n = 6) or without (n = 5) interposed autologous right external iliac vein (REIV) grafts, respectively. Operation time and blood loss were 649 (502–822) min and 1782 (475–6680) mL, respectively. The median length of resected SMV/PV was 40 (20–70) mm, 50 (50–70) mm for REIV grafts, and the splenic vein was resected in eight patients. No patient developed pancreatic fistula; mild leg edema was observed in the six graft patients and the median hospital stay was 36.0 d. PV patency rate at 2 mo after PD was 91% (10/11) and no 90‐d mortality was recorded. R0 resection rate was 91% (10/11). It is feasible to safely reconstruct the SMV/PV using the inverted Y‐shaped technique in appropriately selected PDAC patients.

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Background: T category for pancreatic ductal adenocarcinoma (PDAC) in the Classification of Pancreatic Cancer by the Japan Pancreas Society (JPS) is quite different from that in the American Joint Committee on Cancer (AJCC). The aim is to compare prognosis in PDAC patients undergoing chemoradiotherapy (CRT) based on T categories of JPS and AJCC, focusing on extrapancreatic extension. Methods: This study involved 344 PDAC patients who underwent CRT from 2005 to 2019. T-category variables were re-evaluated on computed tomography (CT) images before and after CRT. Disease-specific survival (DSS) was compared based on T categories of JPS and AJCC. Multivariate analysis was performed to identify prognostic factors. Results: Based on T categories of the AJCC on CT-scan images before and after CRT, 5-year DSS of T3 (57.1% and 50%) were better than that of T2 (37.4% and 34.6%). This reversed phenomenon was not observed based on the JPS. The involvement of superior mesenteric vein (PVsm1) and superior mesenteric artery (Asm1) were significant prognostic factors before and after CRT. Our new T classification, which introduced PVsm1 and Asm1, reflected well the prognosis of patients undergoing CRT. Conclusions: The PVsm1 and Asm1 may be practical for T category in PDAC patients undergoing CRT.