Pancreatic ductal adenocarcinoma (PDA) remains one of the most rapidly progressive and deadly malignancies worldwide. The prevention of pancreatic cancer is difficult to assess, due to limited studies identifying potential risk factors compounded with the multifactorial, heterogeneous nature of the disease. Pancreaticoduodenectomy (PD) is defined as the resection of the pancreas head, the entire duodenum and proximal jejunum associated with anatomical structures closely located and/or whose blood flow is affected by the procedure. Usually, the intrapancreatic and supraduodenal portions of the common bile duct and the gallbladder are also resected; the gastric antrum may be resected or not, depending on the technique adopted. Periampullary carcinoma, carcinoma of the head of pancres, carcinoma of 2nd part of the duodenum, and distal CBD cancers are traditional indications. Chronic pancreatitis with disease involving mainly head of pancreas with severe pain is also an indication . Liver and peritoneal secondaries, celiac lymph node involvement, involvement of the SMA or root of the mesentery. Significant deep infiltration of portal vein precludes the resection, even though resection of portal vein with graft could be done