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Introduction: Distal pancreatic resection (DPR) is a less frequently performed operation than pancreatoduodenectomy with a relatively high perioperative morbidity but low mortality. There is a considerable rate of postoperative pancreatic fistula (POPF). The aim of this study was to evaluate the perioperative outcome in over 100 cases of DPR, with focus on risk factors for POPF and different anastomotic techniques.Patients Methods: On the basis of a prospectively maintained database, exploratory data analysis was performed for all patients who received a DPR from 1994 to 2009. Significance level was set to 5%. SPSS version 17 was used for all statistical analysis. POPF was defined according to the ISGPS definition.Results: From 1994 to 2009, 129 DPR were performed. Indications were adenocarcinoma (29%), chronic pancreatitis (31%), NET (13%), CNP (16%), and others. Median age was 56 years and male : female ratio 40 : 60. For closure of the pancreatic cut surface, a pancreatojejunostomy (43%), direct closure by stapler (14%), hand suture (37%) or seromuscular patch (6%) were used. There were 33% multivisceral resections (including portal vein resections). In multivariate analysis, independent risk factors for perioperative morbidity were the type of pancreatic disease and the surgeon, and risk factors for POPF were a high BMI, the type of closure of the pancreatic cut surface and the surgeon.Conclusion: The main factors influencing morbidity and POPF rates after DPR are the underlying pancreatic disease and the type of anastomosis. The surgeon plays an important role because he chooses the type of operative technique and extent of resection.