The metabolic consequences of total pancreatectomy are manifold. They include weight loss, malabsorption attended by hypocalcemia and hypophosphatemia, diabetes mellitus, diarrhea, and both iron deficiency and pernicious anemia. In theory, total pancreatectomy should provide good surgical treatment for pancreatic carcinoma; in reality, the severe metabolic problems that result from total removal of the pancreas make partial pancreaticoduodenectomy a frequently preferred treatment for most cases of pancreatic carcinoma that are resectable. Because of the frequently multicentric nature of pancreatic cancers, however, some surgeons would rather perform a total pancreatectomy and accept the more complicated postoperative metabolic management entailed by the loss of pancreatic endocrine function.