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The aim of this study was to evaluate long-term pancreatic endocrine function following pancreatoduodenectomy with pancreaticogastrostomy.Records of 52 patients who had survived for three or more years following pancreatoduodenectomy with pancreaticogastrostomy were studied retrospectively. Serum HbA1c levels had been measured prior to and at 3- to 6-month intervals after surgery.Three of 42 patients with normal preoperative serum HbA1c levels (≤5.8%), and five of 10 patients with elevated preoperative serum HbA1c levels (>5.8%) showed deterioration of glucose tolerance. Five of these eight patients developed a pancreatic fistula postoperatively. However, the average serum HbA1c levels of patients with normal preoperative serum HbA1c levels have remained within the normal range for 3- 10 years after surgery.Pancreatic endocrine function was maintained for a long-term period after pancreatoduodenectomy with pancreaticogastrostomy. Impaired glucose tolerance appeared to be associated with postoperative pancreatic fistula formation.