Venous resection at pancreaticoduodenectomy can be safely performed in the presence of jaundice

Venous resection at pancreaticoduodenectomy(PD)has established itself as a viable treatment for borderline resectable cancer,with equivalent survival to those patients undergoing PD for cancer without venous resection[1].Thus surgery for these patients is clearly desirable,when possible,compared to palliative care.However,there is concern and debate about the safety of venous resection at PD[2].There is a need to improve patient pathways,outcome and experience[3].To this end,in patients who present with jaundice,it is clear that surgery without preoperative biliary drainage(PBD)reduces complications[4].In 2015,our team introduced a‘fast track’program to routinely perform PD in the presence of jaundice[5].This change of practice has become routine,with most patients now undergoing surgery without PBD.It is,however,unclear whether portal vein(PV)resection+PD is safe in the setting of jaundice.The aim of this study,therefore,was to compare outcomes and complications between patients with or without jaundice undergoing PD with associated resection of the superior mesenteric vein(SMV)and/or PV.