Aim of the study: TP may be proposed for patients (pts) with diffuse intraductal papillary mucinous tumors of the pancreas (IPMT) or multiples endocrine tumors (mostly associated with MEN-1). Decisions pertaining to TP can be elective when abnormalities are diffuse (e.g., diffuse IPMT) or during surgery where resection margins are involved requiring further resection. Disease-relapse following partial pancreatectomy may also require surgical totalisation. Little data related to survival and morbidity is available. Patients and methods: From 1995 to 2005, 23 patients undergoing TP were retrospectively evaluated. Mean age at TP was 56 [27-76] Years. Indications for TP were: a) non-invasive diffuse IPMT (n=9) or invasive cancer (n=7), multiples endocrine tumors (n=5, 4 with MEN-1), ductal adenocarcinoma (n=1), and relapse of endocrine tumor (n=1); b) totalisation of pancreatectomy was performed in 6 pts for either relapse or incomplete resection performed a median of 2 [0-7] years before. The diagnosis was made preoperatively prior to TP in all patients except 2 (the latter included a case of SLE-related pancreatitis and multicystic chronic fibrosing pancreatitis mimicking IMPT, respectively). Morbidity related to TP and survivals were estimated. Results: Post-operative death was nil. After a median follow-up of 1.4 [0.2-12] years, 16 patients are still alive (5-year actuarial survival=70%). Seven deaths occured form relapse of adenocarcinoma (n=5), late anastomotic ulcer bleeding (n=1) and hypoglycemia (n=1). A reversible hypoglycemic coma and a gastrojejunal anastomotic ulcer were observed in 3 (15%) and 5 (20%) patients, respectively. Among the 8 patients with invasive adenocarcinoma, 5 relapsed at a median of 9 [3-19] months. Among the 8 patients not suspected of having malignant IPMT prior to surgery, 3 were found to have invasive cancer after TP. No patient with endocrine tumors died. Conclusions: After TP: 1) post operative mortality is minimal; 2) mortality due to endocrine insuffisency is 4%; 3) anastomotic ulcers are more frequent than after pancreaticoduodenectomy; 4) when an invasive adenocarcinoma is suspected in cases of IMPT, partial pancreatectomy appears to be a more acceptable treatment option in view of the high recurrence rates; and 5) in light of the possibility of diagnostic errors, TP should not be performed without preoperative histology.