Aggressive arterial resection (AR) or total
pancreatectomy (TP) in surgical treatment for locally advanced
pancreatic cancer (LAPC) had long been discouraged because of their high mortality rate and unsatisfactory long-term outcomes. Recently, new
chemotherapy regimens such as
FOLFIRINOX or
Gemcitabine and
nab-paclitaxel have provided more adequate patient selection and local
tumor suppression, justifying aggressive local resection. In this review, we investigate the recent reports focusing on arterial resection and total
pancreatectomy for LAPC and discuss the rationale of such an aggressive approach in the treatment of PC. AR for LAPCs is divided into three, according to the target vessel. The hepatic artery resection is the simplest one, and the reconstruction methods comprise end-to-end, graft or transposition, and no reconstruction. Celiac axis resection is mainly done with distal
pancreatectomy, which allows collateral arterial supply to the liver via the pancreas head. Resection of the superior mesenteric artery is increasingly reported, though its rationale is still controversial. Total
pancreatectomy has been re-evaluated as an effective option to balance both the local control and postoperative safety. In conclusion, more and more aggressive
pancreatectomy has become justified by the principle of total
neoadjuvant therapy. Further technical standardization and optimal neoadjuvant strategy are mandatory for the global dissemination of aggressive
pancreatectomies.