A 49-year-old woman with a complaint of severe abdominal pain and lumbargo was diagnosed with pancreatic cancer invading the superior mesenteric artery and vein. Since the lesion was unresectable by general Whipple's procedure, she was treated with gemcitabine and opiate. However, these treatments resulted in failure due to the side effects such as bone marrow suppression, severe nausea, and constipation. After the bone marrow suppression disappeared, she received augmented regional pancreatoduodenectomy, which is a pylorus preserving pancreatoduodenectomy with resection of the superior mesenteric artery and vein. Consequently, she could have a good QOL without opiates.

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