The DeBakey Triad: A Technical Innovation Integrating the Triangle Operation, Type III SMV–PV Resection, and ERAS in Pancreatic Head Cancer

Background Borderline-resectable pancreatic head cancer with venous involvement demands an operative strategy that balances oncologic radicality, vascular precision, and postoperative recovery. We describe the DeBakey Triad, a unified technical framework integrating the Triangle Operation, Type III SMV–PV segmental venous resection, and Enhanced Recovery After Surgery (ERAS) principles. Technique Summary The DeBakey Triad consists of three interdependent elements performed in deliberate sequence: Radical mesopancreatic excision (Triangle Operation) to expose the SMA, celiac axis, and SMV–PV confluence. Type III venous resection targeting the fixed post-neoadjuvant tumor–vessel interface, followed by primary SMV–PV end-to-end reconstruction. Structured ERAS integration to support early physiological recovery and reduce postoperative morbidity. This sequence standardizes both technical execution and perioperative workflow for anatomically complex pancreatic head cancers. Illustrative Application We demonstrate the technique using a post-neoadjuvant borderline-resectable case involving SMV–PV confluence involvement. The DeBakey Triad enabled an R0 resection, secure venous reconstruction, preserved postoperative venous patency, and safe discharge in < 100 hours. Conclusion The DeBakey Triad represents an operative innovation that unifies radical dissection, formal venous resection, and enhanced recovery into a cohesive framework. This approach provides clarity, reproducibility, and physiologic advantage in the management of borderline-resectable pancreatic head cancer.