Purpose: To evaluate the indications for and the outcomes from distal pancreatectomy at a single institution. Methods: A retrospective chart review and analysis of all patients who underwent distal pancreatectomy at our hospital between January 1996 and August 2005. Results: Over a 10-year period, 171 patients underwent distal pancreatectomy; mean age was 54 years (range 17-83 years old). The most common indications included cystic (23%) or solid (27%) mass and chronic pancreatitis (7.6%). Nearly one-third of distal pancreatectomies were performed as part of an en bloc resection for a contiguous or metastatic tumor. Fifty-six percent of the patients underwent a standard distal pancreatectomy (+/- splenectomy), whereas 44% of distal pancreatic resections included additional organs or contiguous intraperitoneal or retroperitoneal tumor. Four cases were resected laparoscopically. The overall postoperative complication rate was 39%; the most common complications were pancreatic duct leak, defined as amylase- or lipase-rich drain fluid (26%), intraabdominal abscess (7.6%), and new onset IDDM (3.5%). There were 5 (3%) post-operative deaths. Ten patients (6%) required re-operation, with the most common indication being small bowel obstruction. The median post-operative length of stay was 9 days. Final pathology demonstrated contiguous/metastatic tumor from another organ (29%), mucinous cystadenoma (12%), pancreatic adenocarcinoma (11%), chronic pancreatitis (11%), neuroendocrine tumor (9.9%), and other (11%). Chi-squared analysis and Fisher’s Exact test revealed that when compared to patients undergoing standard distal pancreatectomy, those with a more extensive resection including multiple viscera and/or metastatic or contiguous tumor resection had no significant difference in overall complication rate (38% v. 41%, p=0.610), leak rate (27% v. 24%, p=0.647), new-onset IDDM (3% v. 4%, p=1.0), and mortality (2% v. 4%, p=0.656). Conclusion: Distal pancreatectomy is performed with relative safety for a wide variety of indications. This series includes a large number of patients in whom distal pancreatectomy was performed as part of a multivisceral resection or with en bloc resection of contiguous tumor. Complications were no different in these patients when compared to patients undergoing straightforward distal pancreatectomy. When broadly defined, pancreatic duct leaks were fairly common but usually clinically indolent and easily managed with drains.