The American Hepato-Pancreatico-Biliary Association and Society of Surgical Oncology published a consensus statement in 2009 on the subject of vein resection and reconstruction during pancreaticoduodenectomy (PD), and concluded that PD with vein resection and reconstruction is a viable option for treatment of some pancreatic adenocarcinomas. This article describes the current approaches and recent advances in the management, staging, and surgical techniques regarding portal vein resection. With proper patient selection, a detailed understanding of the anatomy of the root of mesentery, and adequate surgeon experience, vascular resection and reconstruction can be performed safely and does not impact survival duration. Isolated venous involvement is not a contraindication to PD when performed by experienced surgeons at high-volume centers as part of a multidisciplinary and multimodal approach to localized pancreatic cancer.