@breezygirl , with 40% of his pancreas dead, I would ask the docs what good the remainder of his pancreas is currently doing -- specifically whether it's producing enough insulin and digestive enzymes to justify its existence.

If not, a) is total pancreas removal an option vs. distal? That could at least prevent the rest of a "decomposing" pancreas from getting inflamed again or turning malignant; and b) does his condition also require removal of his spleen, or can/should it be preserved?

I'm not a medical expert on any of this, just a patient whose remaining pancreas went rogue (cancerous again) after Whipple. I was at peace with my dependence on enzymes and insulin, but total pancreatectomy __might__ have spared me from needing chemotherapy on top of it.

FWIW, there are several research papers out there on total pancreatectomy vs Whipple, and on spleen-preserving distal pancreatectomy (SPDP) vs distal plus splenectomy (DPS). I haven't read enough to see if there is a consensus, but it sounds like the results are mixed enough that an individual surgeon could consider all the patient-specific tradeoffs and make a recommendation.

From the first paper I scanned: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210976/
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Conclusions

Spleen-preserving distal pancreatectomy using the Warshaw technique is associated with lower postoperative morbidity than DPS. Lower WBC and platelet counts suggest better splenic function in SPDP patients.
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