A liberal midline incision extending from over the xiphoid process down to or below the left of the umbilicus is made (Figure 1). Some prefer an inverted U incision that parallels the costal margins and crosses the midline near the top of the xiphoid process. All bleeding points are carefully controlled. The first decision involves establishing the diagnosis, ascertaining the presence or absence of metastases, and finally, establishing the mobility of the pancreas with special reference to the portal vein. Any evidence of distant metastasis to the omentum, the base of the mesentery of the transverse colon, or to the liver or adjacent lymph nodes makes any procedure palliative. In the absence of metastasis, and in the presence of a freely movable pancreas, further exploration is warranted. The removal of the entire pancreas does simplify the reconstruction of the gastrointestinal tract by a variety of methods (Figures 2 and 3). Only the common duct and the remaining hemigastrectomy remain to be anastomosed to the jejunum.