The preservation of the neurovascular supply to the antrum, pylorus and the first part of the duodenum (APD) via the right gastric (RG) and supraduodenal artery (SPD) is essential for the success of the pylorus-preserving pancreaticoduodenectomy (PPPD) and to prevent delayed gastric emptying (DGE). We analyzed 41 patients with malignant neoplasm and 25 patients with chronic pancreatitis. Preservation of the blood supply to the APD was not possible in 19 patients (46.3%) in the malignant group and DGE occurred in 84.2% of the patients. Furthermore 4 patients had intra-abdominal sepsis and DGE occurred in all patients. The RG and/or SPD arteries were preserved in all patients with benign disease and DGE occurred in 8% of cases. In conclusion DGE is the most frequent complication after PPPD for malignant tumors and is associated with the presence of intra-abdominal sepsis and with the ischemic injury to the APD segment for an oncologically adequate resection.