BACKGROUND:An increasing number of elderly patients have been considered for major surgical procedures, such as pancreaticoduodenectomy. The decision to recommend this operation for localized pancreatic cancer or other periampullary process in a very elderly patient is complicated by the frailty of the patient and the poor prognosis of the disease. Moreover, increased surgical experience associated with better patient selection may reduce the mortality rate, even in very elderly patients (over 80 years of age), after pancreaticoduodenectomy. METHODS:An 84-year-old woman underwent pancreatico-duodenectomy for ampullary adenocarcinoma. The tumor was classiifed pT3N0M0. RESULT:A good postoperative outcome was obtained. The patient is still alive, 18 months after operation. CONCLUSIONS:Radical resection of periampullary tumors is safe in selected patients of advanced age, with morbidity and mortality rates approaching those observed in younger patients. Age alone should not be a contraindication for pancreatic resection.