IntroductionAn increasing number of elderly patients are being diagnosed with pancreatic cancer worldwide with an increasing need to consider major pancreatic surgery in this population. This study aims to provide an updated systematic review and meta-analysis of the recent literature to evaluate the outcomes following pancreaticoduodenectomy in octogenarians. MethodsA systematic review and meta-analysis was performed by identifying eligible studies via a search of Medline, PubMed and Cochrane databases. Studies comparing outcomes of patients aged over 80 years to younger patients undergoing PD were included. ResultsA total of 26 studies were included for review which included a total of 22,481 patients with 20,134 (89.6%) patients aged <80 years old, and 2347 (10.4%) octogenarians. Octogenarians were associated with higher mortality rate (OR 2.37 (95%CI 1.91–2.94, p < 0.00001)), higher rate of all-cause morbidity (OR 1.60 (95%CI 1.30–1.96), p < 0.00001) and higher re-operation rates (OR 1.41 (95%CI 1.13–1.75), p = 0.002). Octogenarians has a two-fold risk of cardiac complications (OR 2.13 (95%CI 1.67–2.73), p < 0.00001) and respiratory complications (OR 2.38 (95%CI 1.72–3.27), p < 0.0001). There was no difference in postoperative pancreatic, fistula, post-pancreatectomy haemorrhage or delayed gastric emptying. In a subgroup analysis, younger patients were more likely to return to adjuvant therapy compared to octogenarians (OR 0.20 (95%CI 0.12–0.34), p < 0.00001). ConclusionsCompared to younger patients, octogenarians are associated with higher mortality rate, postoperative complications, and reduced likelihood to undergo adjuvant therapy for pancreatic cancer. Careful preoperative assessment and selection of elderly patients for consideration of major pancreatic surgery is essential to ensure patients are provided optimal care.