Extended pancreatic resections have still a significative morbidity: this explains all the technical alternatives proposed to the Whipple procedure. Treatment of the pancreatic stump after cephalic resection and the need of gastric resection are particularly debated today. The Authors, together with a wide literature review, report their experience with 45 patients who underwent cephalic (28 cases), subtotal (4 cases) or total (13 cases) pancreatectomy. Telescope pancreaticojejunostomy showed overall satisfying results (7% of dehiscences), inducing the Authors to use it in all cases. The role of pyloric preservation as proposed by Traverso and Longmire, which strongly reduces nutritional sequelae of pancreatectomy without negative effects on oncological radicality, is emphasized.