With advancements in surgical techniques and the application of neoadjuvant and conversion therapies, arterial resection and reconstruction offers a potential curative option for patients with locally advanced pancreatic cancer. Preoperative meticulous assessment of arterial involvement using imaging, combined with biological markers and the patient's physical status, allows for strict patient selection. Intraoperative strategies such as the “artery-first approach” and “sub-adventitial divestment” can be employed to determine the feasibility of radical resection. For arteries that cannot be preserved, procedures such as celiac axis resection, hepatic artery resection, or superior mesenteric artery resection and reconstruction may be performed depending on the site of involvement. Given the technical complexity of arterial resection and the associated high morbidity and mortality rates, this procedure should be carried out in high-volume pancreatic centers with extensive experience, and further large-scale studies are needed to validate its long-term efficacy.