In patients with resectable adenocarcinoma of the head of the pancreas, pancreaticoduodenectomy serves as the cancer-directed operation of choice. The pylorus-preserving modification of pancreaticoduodenectomy is commonly performed in this setting. Reconstruction of the gastrointestinal tract following pylorus-preserving pancreaticoduodenectomy can be accomplished using various techniques. The operative mortality rate in experienced hands is generally less than 3%, with a postoperative complication rate in the range of 35% to 40%. Patient survival following resection is largely determined by tumor biology, based on such parameters as tumor diameter, lymph node status, resection margin status, and DNA content, and is not adversely influenced by pylorus-preserving pancreaticoduodenectomy.