Delayed gastric emptying after pancreatoduodenectomy in patients with pancreatic cancer is a frequent complication resulting in patient inconvenience and prolonged hospital stays. The objective of this prospective study was the comparative analysis of gastric emptying in 2 groups of patients: those undergoing the classic Whipple procedure, and those undergoing pylorus-preserving pancreatoduodenectomy. Delay in gastric emptying was defined in our study as vomiting or the need for a gastric tube after the 5th day, with a reflux of > 500 ml/day. Clinically, 3 of 15 patients (20%) with the pylorus-preserving Whipple procedure had motility disturbances, compared with 4 of 7 patients (57%) in the classic Whipple group (p = 0.05). Radiologically, delayed emptying was found in 2 of 15 patients (13%) in the pylorus-preserving group and in 6 of 7 patients (86%) in the classic Whipple group (p < 0.01). Due to delayed gastric emptying, hospital stays were longer in the classic Whipple group than in the pylorus-preserving group (median 22 days, range 19-240 days, versus median 18 days, range 13-90 days; p < 0.02). Hospital mortality was 0% in both groups. Due to the low morbidity and mortality as well as to the lower incidence of delayed gastric emptying, the pylorus-preserving Whipple procedure is recommended in patients with pancreatic head cancer and with duodenal or periampullary tumors.