Locally advanced cancer of the body of the pancreas often involves the common hepatic artery (CHA), and/or celiac axis (CA) with perineural invasion of the nerve plexuses surrounding these arteries. It is thus regarded as borderline resectable or unresectable disease, according to the NCCN Guidelines Version 2.2015. This procedure was originally designed for en bloc lymphadenectomy for advanced gastric cancer with combined total gastrectomy by Appleby in 1953 and was applied first for patients with advanced pancreatic body cancer by Nimura in 1976. This chapter covers the arterial supply to liver and stomach in patient who underwent DP-CAR, indications for DP-CAR and the surgical procedure, postoperative course following DP-CAR, longterm outcome following DP-CAR, and modification of DP-CAR.