Vascular resection and reconstruction at the time of pancreaticoduodenectomy (PD) adds complexity to an already demanding operation. In this chapter, we review the indications, surgical techniques, and most recent results of venous resection combined with PD. The need for venous resection may not always be apparent on preoperative imaging, and surgeons who perform PD should be familiar with standard techniques necessary for vascular resection and reconstruction. Recent data suggest that with proper patient selection and surgeon experience, vascular resection and reconstruction can be performed safely and does not impact survival duration even in patients with pancreatic ductal adenocarcinoma. The median survival of patients who underwent PD and required vascular resection was 23 months, approximately 1 year longer than the survival of patients with locally advanced, surgically unresectable pancreatic cancer who receive palliative chemotherapy or chemoradiation.