Case summary: we report a 73 years old male patient who suffered from abdominal pain and lose of weight. The abdominal CT scan showed the tumor in head of pancreas with SMV involved. We performed the biopsy by EUS-FNA, which showed the tumor cell. The diagnosis was borderline resectable pancreatic carcinoma. According to the guideline, we performed the neoadjuvant chemotherapy. The regimens was nab paclitaxel + S-1 for 4 cycles. After 2 months neoadjuvant chemotherapy, the CT scan showed the tumor regression and the tumor marker (CA19-9) decreased from more than 1000 to 162 U/ml. Then we performed the open pancreaticoduodenectomy with segmental resection and reconstruction of SMV. Because of the tumor invasion of SMV, we performed the surgery by artery first approach. The diagnosis of pathology was pancreatic ductal adenocarcinoma(pT2N0M0) and partial response to neoadjuvant chemotherapy. We performed the adjuvant chemotherapy after surgery. The regimens was Gemcitabine + S-1 for 4 cycles. 2 months after surgery the CT scan showed no recurrence or metastasis.