Objective: To evaluate the reliability of using POSSUM scoring system for risk estimation in elderly patients undergoing pancreaticoduodenectomy (PD). Methods: Eighty patients undergoing PD between February 2011 and February 2010 were divided into two groups according to their ages. Of the patients, 38 cases ≥80 year old were allocated to observational group, and the other 42 cases >80 years old served as control group. The intra- and postoperative conditions of the two groups of patients were analyzed, and the POSSUM scores between the two groups as well as the difference between the POSSUM predicted and actual incidence of complications and mortality in the two groups were compared. Results: In observational group, the operative time, intraoperative blood loss and blood infusion requirement showed no significant difference versus control group (all P>0.05), but length of hospital stay was longer than that of control group (P<0.05). The POSSUM score in observational group was significantly higher than that in the control group (P<0.05); there was no significant difference between the predicted and actual incidence of complications and mortality in observational group (P>0.05), but both actual incidence of complications and mortality were significantly lower than those of predicted values in control group (P<0.05). Conclusion: Application of POSSUM scoring system can provide a relatively accurate estimation of the surgical risk in elderly patients undergoing PD, so it has guiding significance for these patients in perioperative management.