Total pancreatectomy (TP) is an absolute indication for the treatment of patients with total pancreas without liver metastases and retroperitoneal invasion. Its advantages include complete removal of multiple lesions in the pancreas, more convenient and complete removal of peripancreatic lymph nodes, and complete avoidance of pancreatic fistula. The involvement of the superior mesenteric vessels becomes an important factor affecting the further implementation of this procedure, because the portal vein blood flow blockage required in total pancreatectomy combined with superior mesenteric vascular resection and the preoperative obstructive jaundice make the patient very prone to postoperative liver insufficiency or even liver failure. To date, there are no good measures to prevent and treat ischemia-reperfusion liver injury caused by this portal vein blockage. To avoid the occurrence of postoperative hepatic insufficiency or liver failure, surgeons mostly choose to forgo surgical treatment or perform palliative surgery, which greatly reduces the radical surgical resection rate and surgical efficacy of such patients. The liver cold perfusion technique has been widely used for the preservation of donor liver in organ transplantation and for the protection of liver ischemia caused by whole liver blood flow blockage during lobectomy, and it can significantly reduce the ischemia-reperfusion liver injury caused by liver blood flow blockage. We applied this technique to total pancreatectomy with invasion of the superior mesenteric vessels and performed a successful salvage operation for a patient. The patient was a 66-year-old female who was admitted to the hospital with abdominal distension and poor circulation for 2 months and high fasting glucose for 20 days. On examination, there were no obvious positive signs in the abdomen, CEA 27.85ng/ml, CA242>200ku/ml, CA125 136.29ku/ml, CA19-9>1940.0U/ml, CT and MRI showed hypodense occupying lesions in the head of the pancreas and small hypodense occupying lesions in the body of the pancreas, considering cancer of the head of the pancreas with caudal metastasis, the beginning of the portal vein The preoperative diagnosis of pancreatic head cancer with caudal metastasis was clear, and there were no obvious contraindications to surgery. The operation was performed under routine tracheal intubation and intravenous general anesthesia, and a 1 cm inverted T-shaped incision was made above the umbilicus to enter the abdomen layer by layer. The liver was soft, with normal color, morphology and size, and no obvious nodule-like lesions were found. The size and morphology of the gallbladder were normal, and the diameter of the common bile duct was about 6 mm. The whole pancreas was hard when the gastrocolic ligament was opened, the duodenum was partially invaded, and the superior mesenteric vein, portal vein, splenic vein and mesenteric artery were also invaded by the tumor HYPERLINK”. III. Results Postoperative treatment with rehydration, anti-infection and nutritional support was given, and the patient recovered smoothly without thoracic and abdominal infections, bile leak, intestinal leak, and infected incisional dehiscence. Blood glucose could be maintained at the level of 6-8 mmol/L with the application of insulin, and the number of stools was 2-3 times. The postoperative pathological diagnosis was moderately differentiated adenocarcinoma of the pancreas. At 3-month follow-up, the patient was generally well, with weight gain, relief of abdominal pain, and blood glucose maintained at 6-8 mmol/L with insulin, with good results, but diarrhea still occurred from time to time. No tumor recurrence has been seen.