Lecture : Purpose: Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) has been widely performed for advanced pancreatic body cancer. Meanwhile, its modified procedure with preservation of the left gastric artery (LGA) has been employed in selected patients in order to avoid ischemic trouble of the stomach following surgery. In this presentation, the procedures of the standard DP-CAR as well as the modified technique will be presented. Surgical techniques: [Standard DP-CAR] In the 1st-step (dorsal) approach, bottoms of the celiac (CA) and superior mesenteric artery (SMA) are exposed in bilateral side with exposing the bilateral crus. Bilateral ganglions, and retroperitoneal tissue including the left adrenal gland and the left perirenal fat are dissected completely. SMA plexus is divided at its dorsal side from the bottom toward the distal side 4 to 5cm in length. In the 2nd-step (ventral) approach, transection of the pancreas after dividing the common hepatic artery is performed. In the 3rd-step (medial) approach, the plexus of SMA is divided at its dorsal side by continuing the division which made in the 1st step. The plexus is transected horizontally across SMA to the right side from the left. The dissection is continued toward the bottom of CA along with the uncinate process of the pancreas. CA is divided with double ligation including single transfixation. [Modified DP-CAR] This procedure should be performed in patients with less invasive tumor which was localized in ventral side of CA. LGA is exposed at near the stomach wall and dissected longitudinally toward CA. In just distal side of the origin of LGA, CA is exposed circumferentially and divided after confirmation of cancer negative in its plexus. After dividing CHA and pancreatic parenchyma, the dissection around SMA and retroperitoneal space is conducted in the similar manner with the anterior or posterior RAMPS. SMA plexus of 0 to 180 degree could be dissected depending on the severity of tumor extension. Conclusion: The standard and modified DP-CAR are quite different in their areas of excision, especially for the retroperitoneal tissue. Selection of patients for each procedure is the most important issue to achieve R0 resection.