Mizuno S, Kato H, Yamaue H, et al. - Researchers aimed at determining the frequency of developing left-sided portal hypertension (LPH) and its effects on the long-term outcomes of patients with pancreatic cancer treated with pancreaticoduodenectomy (PD) and resection of the portal vein (PV)/superior mesenteric vein (SMV) confluence. Among 536 enrolled patients who underwent PD with PV/SMV resection, comparison of the SVp group [n=285; the splenic vein (SV) was preserved] and the SVr group (n = 227; the SV was divided and not reconstructed) was mainly performed. In the SVr group, the incidence of variceal formation increased until 3 years after PD compared with that in the SVp group (38.7% vs 8.3%). The SVr group (n = 9: 4.0%) but not the SVp group, had occurrence of variceal bleeding. Overall outcomes revealed that PD with SV division results in variceal formation, bleeding, and thrombocytopenia.