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Background Surgery offers the only chance for cure in patients with pancreatic adenocarcinoma, and a growing number of elderly patients with the disease are being offered resection. Recent studies report safety and long-term survival for pancreaticoduodenectomy in patients older than 70 years, yet few specifically evaluate patients older than 80 years. Objective The aim of this study was to examine morbidity, mortality, and survival of patients aged 80 years and older undergoing pancreaticoduodenectomy. Methods Between February 1992 and June 2009, 105 patients aged 80 years and older were brought to the operating room for pancreatic resection. Of these patients, 96 underwent pancreatic resection with 68 undergoing pancreaticoduodenectomy. During this time period, 658 patients less than 80 years old also underwent pancreaticoduodenectomy. These records were retrospectively reviewed to compare demographics, perioperative characteristics, and outcomes between patients older and younger than 80 years. Continuous variables were compared using Student’s t-test or Wilcoxon rank-sum test. Categorical variables were compared using chi-square or Fisher’s exact test. For survival, Kaplan-Meier analysis was performed, and median survival was compared with the log-rank test. Results In patients 80 years and older, pancreaticoduodenectomy was most commonly performed for pancreatic adenocarcinoma (n=43, 63%), intraductal papillary mucinous neoplasm (n=5), ampullary adenoma (n=5), ampullary adenocarcinoma (n=4), cystadenoma (n=3), and pancreatic neuroendocrine neoplasm (n=2). Patients 80 years and older were statistically similar with respect to sex, race, median blood loss, reoperation rate, postoperative length of stay, and readmission rate when compared with younger patients who also underwent pancreaticoduodenectomy. Patients 80 years and older had shorter mean operative times (410 minutes vs. 510 minutes, p<0.0001). There were no differences in overall complications (50% vs. 53%, p=0.67), major complications (16% vs. 25%, p=0.12), and mortality (4% vs. 4%, p=0.76). In a subset of all patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, patients 80 years and older (n=42) had a median survival of 11.6 months compared to 17.8 months in younger patients (n=322; p=0.004).Conclusion Pancreaticoduodenectomy can be performed safely in patients aged 80 years and older, and age alone should not dissuade surgeons from offering these patients pancreatic resection. Elderly patients with pancreatic ductal adenocarcinoma appear to have shorter survival than younger patients with the same disease.