The perioperative results with pancreatic resection have improved dramatically during the last decade. At high-volume centers, perioperative mortality has been consistently reported to be less than 5% following pancreaticoduodenectomy. Similarly, distal pancreatectomy can be accomplished with minimal morbidity and rare mortality. Despite these improved results, a few problems remain. One such problem is that cysts and tumors arising in the midbody of the pancreas may not be optimally managed by either distal pancreatectomy or pancreaticoduodenectomy. In many cases the central location of these tumors, which are most often benign if truly candidates for resection, requires a significant extension of the resection either proximally toward the head or distally to include the tail-sacrificing normal pancreatic tissue. These extensive resections frequently result in either pancreatic exocrine or endocrine insufficiency, and with distal pancreatectomy often necessitate splenectomy.