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Background: Pancreaticoduodenectomy is increasingly being offered as treatment for periampullary tumours in patients 80 years and older. Our aim was to evaluate clinical outcomes of pancreaticoduodenectomy in octogenarians from two high-volume tertiary HPB centres. Materials and Methods: A retrospective case-control analysis of a prospectively-maintained database, between January 2008 and December 2017, was performed. Octogenarians who underwent pancreaticoduodenectomy were matched with consecutively-operated younger patients with 1:1 ratio, based on extent of surgery (venous, arterial or additional resection). Pre-operative comorbidities, intraoperative variables, post-operative complications and mortality were compared, with statistical significance at p<0.05. Results: 88 octogenarians (median age 81 years,range:80-90) who underwent pancreaticoduodenectomy (either classical or pylorus-preserving) were compared to similar number of controls (median age 66 years,range:16-79). Gender, ASA (octogenarians median grade 2 [range:1-4] versus median grade 2 [range:1-3] for controls) and performance status (median score 0 [range:0-2] for both groups) were comparable (p=1.00,p=0.18 and p=0.11 respectively). Charlson Comorbidity Index scores were higher overall for octogenarians (median 7 [range:6-10] versus 5 [range2-9],p=0.001). Median LOS was comparable, 15 days (range:5-69) for octogenarians and 12 days (range:5-78) for controls (p=0.12), as was median ICU stay, 2 days (range:0-58) for octogenarians versus 2 days (range:0-25) (p=0.40). Negative resection margin (R0) rates were 64% for octogenarians and 59% for controls (p=0.53), with no significant difference in lymph node status (p=0.53). Overall post-operative complication rate was higher in octogenarians (60% versus 49%); however this was not statistically significant (p=0.17). Similarly, complication rates across the Clavien-Dindo classification categories were not statistically significant. 30-day and 90-day mortality were 2.3% and 8% for octogenarians versus 1.1% and 3.4% for controls (p=1.0 and p=0.33 respectively). Conclusion: Despite higher 90-day mortality, pancreaticoduodenectomy outcomes in octogenarians are comparable to their younger counterparts. Pancreaticoduodenectomy should therefore be offered as a curative surgical option in this cohort, in specialised centres after meticulous pre-operative assessment.