<p>Borderline resectable pancreatic cancer may require a more extensive surgery with vascular resection. Vascular resection can imply an inadequate gastric venous outflow and subsequently higher rates of reoperation, gastrectomy, and postoperative morbidity and mortality. We present a case of a venous anastomosis to prevent insufficient gastric venous outflow. A 59-year-old woman patient with a borderline resectable pancreatic cancer underwent a total pancreatoduodenectomy with splenectomy, atypical gastrectomy, and an anastomosis between the left gastric vein and the inferior mesenteric vein to achieve an oncological R0 resection and to facilitate an adequate gastric venous drainage. This venous anastomosis could present an alternative gastric venous drainage, for optimizing patients after pancreatic cancer resection.</p>