Abstract: Objective :To explore the POSSUM scoring system in prediction of the post-operative complication and the hospital mortality for pancreaticoduodenectomy in the elderly patients over 65 years of age. Methods :A total of 68 patients(65 years)with the head of pancreas or periampullary carcinomas undergoing Whipple' s procedure from Jan 1995 to Dec 2004 were included for statistical analysis and POSSUM scoring during peri-operative period,and the outcomes were compared between the patients over 65 years(the elderly group)and those under 64(the younger group). Results :The post-operative complication rate of the elderly group was 36.7%,the hospital mortality was 11.7%;the younger group was 20.1% and 2.3%.The post-operative complication of the elderly group was pneumonia,arrhythmia and acute renal failure.The hospital mortality was caused mostly by acute renal failure and multiple organ dysfunction syndrome(MODS).The POSSUM scoring during peri-operative period in the elderly group was correlated with the post-operative complication rate or the hospital mortality. Conclusion :Pancreaticoduodenctomy is of high risk in elderly patients,the POSSUM scoring system can predict the outcome for the elderly patients with the head of pancreas or peri-ampullary carcinomas,and this information can be of benefit to the peri-operative management.