Background: Surgical resection for pancreatic ductal adenocarcinoma of the neck, body and tail (PDAC-NBT) accounts for 11.5% of all pancreatectomies. Of those, only 20% are performed on patients older than 80 years. This study characterizes this extremely small population of octogenarian patients with left-sided PDAC to establish their unique clinicopathologic, surgical, and treatment outcomes. Methods: Patients at five high-volume pancreatic centers with PDAC-NBT who underwent surgical resection with curative intent were retrospectively analyzed. Clinical, radiographic, pathologic, and treatment outcomes for the octogenarian cohort were compared to those of younger patients. Results: 370 patients were surgically treated between 2001 and 2016. Of those, 44 patients were greater than or equal to 81 years of age at diagnosis. Compared to patients aged less than 61 (n = 87), octogenarians exhibited no differences in presentation symptoms but exhibited significantly lower BMI (24.4 vs 29.2, p < 0.0001). Clinical characteristics were similar except that octogenarians presented with smaller tumors (3.4 cm vs 5.1 cm, p = 0.016) and were more likely to have elevated CA 19-9 (88% vs 52.9%, p = 0.020). The use of neoadjuvant therapy was similar between all age groups, but adjuvant chemotherapy was significantly under-utilized in octogenarians (36.6% vs 80.5%, p < 0.00001). Surgically, octogenarians had significantly shorter operative time (247 vs 300 minutes, p = 0.04), had fewer lymph nodes recovered (14.3 vs 22.2, p = 0.03) and were more likely to undergo a non-R0 resections (38.5% vs 18.5%, p = 0.02). Postoperatively, there were no differences in blood transfusions, complications, pancreatic fistulas, or hospital length of stay. Pathologically, no differences were found between tumor stage, lymph node ratio, perineural or lymphovascular invasion. Likewise, there were no significant survival differences attributable to age. Conclusion: Octogenarians with PDAC-NBT have significant differences in surgical and medical treatment metrics, including lower rates of R0 resection and adjuvant therapy. Despite this, there were no overall differences in perioperative morbidity, mortality, or survival. These data suggest that resection should be pursued in the appropriately selected octogenarian as outcomes are not associated with age-related clinicopathologic factors.