Pancreatic head cancer spreads along the superior mesenteric artery (SMA) lymphatically and perineurally. The conventional surgical treatment has limitations as to how much of the involved area can be resected due to complications caused by the involvement of the SMA and the superior mesenteric vein (SMV). To completely resect the involved tissue this key area should be removed with the SMA as well as the SMV. However, many surgeons elect not to remove the SMA, resulting in limited ability to carry out complete, local resection. This in turn results in higher instances of loc-regional pancreatoduodenectomy (ARPD) procedure addresses this issue. ARPD's has two advantageous characteristics, an ideal regional dissection and no-touch isolation. The procedure is divided into 4 steps: (1) identification of the origin of the SMA, (2) identification of the SMA and the SMV at the root of the mesentery (3) isolation of the hepatic artery and the portal vein at the suprapancreatic portion ad (4) reconstruction of the SMA and the SMV. First, the retroperitoneum is open at the left side of the Treitz's band to identify the SMA's origin. Secondly, the middle and right colic and 1st to 3rd jejunal vessels are cut off at the level of the duodenal third portion, respectively, and the SMA and the SMV are identified. Then the jejunum is dissected at the same level. Thirdly, the common hepatic duct is cut, and the soft tissue around the proper hepatic artery and portal vein is dissected. The duodenum is dissected at the 2nd portion. The pancreas body is divided at a tumor-free location. After that, we perform Kocher's maneuver at the layer just behind the pre-renal fascia. Now the pancreas head is connected only with the SMA and the SMV. Finally, vascular reconstruction is performed stepwise, firstly the SMA and secondly the SMV. The SMA is resected between its origin and the mesenteric portion and reconstructed with a saphenous vein graft. The involved SMV is also likewise resected and reconstructed with an external iliac vein greaft. This surgery was applied to 9 cases of pancreatic cancer involving the SMV and in 2 cases the SMA was also involved. Pre-operative CT scan of these patients indicated a lack of hepatic matastasis and no swelling of the paraaortic nodes. These conditions indicated the use of ARPD. One patient had a complication of an intestinal fistual. Diarrhea, the number one postoperative complaint, could be controlled with antidiarrhetics. Eight patients have survived for 24, 20, 14, 12, 12, 8,3 and 2 months, respectively, and three died from the recurrence at 22, 14 and 12 months, respectively. We have observed, as yet, no loco-regional recurrence. This technique allows for increased resectability and higher curability.