During the last decade, the outcome after pancreaticoduodenectomy (PD) for cancer showed a continuous improvement. Therefore, an increasing number of patients, especially elderly patients, have been considered for this procedure. However, the debate on the possible deleterious influence of patients' advanced age on their postoperative outcome after pancreaticoduodenectomy still continues. From June 1995 to October 2003, 70 elderly patients (range, 70-84 years) underwent pancreaticoduodenectomy with pancreato-gastrostomy for cancer. Among them, 38 patients were 70-75 years old and 32 were > or =75 years. Patients were identified from a prospective database of a single institution, and their records were reviewed retrospectively. Patient and tumor characteristics, postoperative morbidity and mortality, length of hospital stay, readmission rate, and overall survival were compared between the two groups. There were no statistical differences regarding the postoperative mortality (P = 0.205), overall morbidity (P = 0.267), mean length of hospital stay (P = 0.345), and readmission rate (P = 1) between both groups. Only delayed gastric emptying was significantly more frequent in patients > or =75 years (P = 0.039). The median overall survival was 20 months. Survival was significantly influenced by the pathological type of the tumor, with worse results for patients with ductal pancreatic adenocarcinoma. In elderly patients, age does not seem to influence the postoperative outcome after pancreaticoduodenectomy with pancreato-gastrostomy.