After pancreatic cancer surgery with vascular resection, portomesenteric venous thrombosis (PVT) is frequently encountered, particularly late PVT, which has significant implications for patient outcomes.

• Early PVT occurred in 3.3% of patients, with incidence dropping from 12% to 1.6% following standardization of surgical techniques.
• Late PVT affected 21.5% of patients, typically diagnosed around 7.4 months post-surgery, and is associated with local recurrence in 75% of cases, leading to significantly shorter recurrence-free survival (median 9.0 vs 16.3 months).

Surgeons should consider the occurrence of late PVT when assessing surgical candidates, especially those undergoing neoadjuvant radiotherapy and at risk of local recurrence.