Lecture : Abstract Background Although Total pancreatectomy (TP) is performed at an increasing rate at major pancreatic centers, there is still debate regarding its indications and outcomes. This study aimed to analyze the indications and outcomes of TP. Methods We conducted a retrospective study of 64 patients who underwent TP between January 2011 and December 2019 at two academic hospitals using data collected from an institutional review board-approved prospective database. The preoperative data, including demographic data and clinical picture, operative details, and postoperative data were collected and analyzed. Conventional indication of TP were positive margin, diffuse lesions on whole pancreas. Results During study periods, 70 TP were performed for benign and malignant pancreatic diseases. After excluding six TP undergone due to trauma or complication, 64 consecutive elective TP underwent. Indication of TP were for intraductal papillary mucinous neoplasms (IPMN) (n=14, 21.9%), pancreatic adenocarcinoma (n=40, 62.5%), other neoplasm (n=9, 14.1%), and chronic pancreatitis (n=1, 1.6%). We compared clinical data between conventional indication (n=47, 73.4%) and risky glands (n=17, 26.6%). Risky glands were fatty pancreas (n=5), atrophic remnant (n=5), severe inflammation on remnant (n=4), and small p-duct (n=3). There was no significant difference of clinical data between two groups. 33 patients (51.5%) underwent a planned TP and 31 patients underwent a single-stage unplanned TP after an initial partial pancreatectomy. Thirty-day major morbidity and mortality was 9.4% and 0%, respectively. With a median follow-up length of 21.5 months, 47 (73.4%) patients were alive at last follow-up. Median HbA1c values at 12 months after surgery were 7.8. Conclusions Total pancreatectomy appears to be an appropriate option for selected patients with conventional indication and be a viable option for risky glands in terms of surgical safety.