Inclusion Criteria:  pylorus-preserving pancreaticoduodenectomy ECOG scale 0-1 Age > 19 Appropriate organ function as below i.WBC : ≥2500 mm3, ≤14000 mm3 ii.Hemoglobin : ≥9.0 g/dL iii.Platelet : ≥100,000 mm3 iv.Total bilirubin : ≤2.0 mg/dL (except for occlusive jaundice) v.Creatinine : ≤2.0 mg/dL patient who can understand and sign the informed consent  Exclusion Criteria:  previous history of gastrectomy ulcerative scar around ampulla of duodenum on endoscopy previous history of upper abdomen surgery (open) Emergency Severe ischemic heart disease Severe hepatic failure by liver cirrhosis or hepatitis Severe respiratory failure that requires oxygene inhalation Chronic renal failure that requires hemodialysis Expecting combine resection of other organ Immunosuppressive therapy Accompanying cancer with potential for adverse events Severe psychologic or neurologic disease drug or alcohol addiction