Th risk to benefit far outweighs a total pancreatectomy. The vast majority of progression is not from a new primary developing in the remnant pancreas or not having an RO margin, it is because there is micrometastatic disease that has already occurred and undetectable by conventional imaging methods. Doing a complete pancreatectomy will do nothing about micrometastatic disease. I cases where there is certain germline mutations that are associated with repeated development of new primary cancers making a family member diagnosed with pancreatic cancer an extreme risk to develop a new primary, then a surgeon would entertain that possibility of removing the entire pancreas vs waiting and frequent surveillance.

There are many factors that go into a decision to remove the entire pancreas. In general, it is rarely done for pancreas adenocarcinoma when we are able to do a Whipple or a distal pancreatectomy. Mainly, this is because the vast majority of recurrences are not within the pancreas, but are to distant organs such as the liver or lungs. Removing the whole pancreas does not seem to prevent this. For cases of cancer, we do not preserve the spleen, as there are important lymph nodes near the spleen that need to be removed to properly "stage" the cancer. We will rarely preserve the spleen for pre-cancerous lesions or certain types of neuroendocrine cancers, but this also depends on many patient factors.