Based on these data, however, laparoscopic distal pancreatectomy appears to be at least as safe as open distal pancreatectomy. Currently, either technique is considered the "standard of care" at Indiana University Hospital as well as several other institutions in the US with expertise in laparoscopic pancreas surgery. To determine whether laparoscopic distal pancreatectomy is truly superior to open distal pancreatectomy in terms of outcomes, we have proposed to randomize patients to laparoscopic vs open distal pancreatectomy. In addition to the randomization, patients will be preoperatively stratified according to whether there is a diagnosis of pancreatic adenocarcinoma, so outcomes in this specific group of patients may be examined. Patients with adenocarcinoma will be randomized separately to insure equal groups in laparoscopic and open distal pancreatectomy groups for this specific diagnosis. Patients with neuroendocrine/islet cell tumors will also be randomized separately to insure equal groups in laparoscopic and open distal pancreatectomy groups for this specific diagnosis. Laparoscopic distal pancreatectomy for adenocarcinoma and neuroendocrine/islet cell tumors is uncommon (e.g., only 9 adenocarcinomas in last 5 years were performed laparoscopically at IU), thus it is clear from the outset that conclusions will be limited about patients with these diagnoses. Although this is being submitted as a single institution study, it will be strongly considered for multi-institutional study design in the near future. Patients will be enrolled on an intention-to-treat manner. Thus, patients who are randomized to laparoscopic distal pancreatectomy who require conversion to open pancreatectomy will still be included in the laparoscopic group in the overall comparative analyses. Subgroup analyses, however, will also be performed excluding this cross-over group.