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Background: The outcomes of complex major surgery in the elderly are being scrutinized because of the demands on surgical services by an aging population and the concern whether such endeavors are justified. Pancreatoduodenectomy (PD) for pancreatic adenocarcinoma presents special challenges because of the high morbidity of the procedure, dismal prognosis of the disease, and the increasing incidence of pancreatic cancer with age. Methods: All patients who underwent PD for pancreatic adenocarcinoma from 1981 to 2007 were analyzed for peri-operative outcomes, tumor-related parameters, use of adjuvant therapy, and long-term survival. Specifically those aged ≥80 years were compared with a control group aged ≤80 years. Continuous variables are displayed as median and interquartile range (IQR); Log rank test and Cox’s proportional hazards were used to determine survival and effect of age as an independent marker against other co-variates.Results: Fifty three patients aged ≥80 years underwent PD. Twenty six (51%) developed complications, including delayed gastric emptying (9;17%), pancreatic leak (6; 11%) and post-operative bleeding (5; 9%). There was one in-hospital death (2%). The hospital stay was 13.5 days (IQR 9-19). Forty one (79%) patients were discharged home, of the 11 (21%) patients who went to an outside health care facility (pancreatic leak / drains and feeding issues- 5, delayed gastric emptying / nutritional - 4, no home support- 1), one died in a nursing home at 5 months while the other 10 patients returned to their previous abode (median 4 weeks). The median survival was 13.5 months (IQR 12-21.3). Compared to the non-octogenarians (n= 567), the older population had more poor risk patients with respect to ASA status (P<.0004), stayed longer as in-patients (P.04), were more likely to develop complications (P<.001), and were less likely to receive adjuvant therapy (P<.0001). There was no difference in long-term survival (Log rank P.14), and age did not appear to be an independent marker of prognosis when analyzed (Cox’s proportional hazards - P.26, Chi square 1.25).Conclusions: In experienced institutions, PD for ductal adenocarcinoma is a viable option in the ambulatory octogenarian population who are deemed operative candidates for a PD. The trade off is a greater complication rate and the prospect of discharge (1 in 5) to a chronic care facility. The majority, however, can be discharged home with a reasonable functional status, and those discharged to temporary healthcare rehabilitation facilities are likely to make a recovery over a few weeks.