With the development of social economy and medical science, the number of elderly people is increasing, however, the diagnosis and treatment of diseases in elderly people can be affected by various factors such as age, cardiopulmonary function, disease status, and choice of treatment. I would like to share with you some typical cases that I have recently encountered: The patient, a 76-year-old male, visited a local hospital for “difficulty in eating for more than one month”. Enhanced CT examination showed “a large mass in the head of the pancreas compressing the duodenum and bile duct”. The patient’s condition was discussed in detail: the patient was 76 years old and the giant tumor in the head of the pancreas had invaded the duodenum and biliary tract, and caused the patient to have difficulty in eating for more than a month, and her general nutritional status was extremely poor. For the radical surgery of pancreatic head tumor – pancreaticoduodenectomy is the largest surgery in the general surgery system except liver transplantation, which has extremely high requirements on the basic physiological conditions, tissue and organ functions, and nutritional status of the patient. In addition, some of the family members were divided about the treatment of the senior patient, mainly because they considered whether it was still necessary to perform such a major surgery when the patient was so old, and if postoperative complications might lead to more serious consequences. However, this patient was unable to eat because the tumor was completely compressing the duodenum, and the quality of life was extremely poor if the tumor was not removed. After full communication with the family, we carefully formulated a precise and detailed surgical plan for this patient under the guidance of the concept of precise hepatobiliary and pancreatic surgery and based on CTA 3D reconstruction, including all aspects of surgical access, organ dissection sequence, clearance scope, vascular treatment, pancreatic stump reconstruction method and biliary tract reconstruction method. Meanwhile, various preoperative preparations, including nutritional support and psychological counseling, were carried out. On June 11, 2014, a standard pancreaticoduodenectomy was performed at the General Hospital, with surgical resection of the head of the pancreas, all of the duodenum, gallbladder, common bile duct, and distal half of the stomach, with pancreatic duct-jejunal mucosal microanastomosis, pancreatic stump-jejunal plasma membrane ruffled anastomosis, common hepatic duct-jejunal end lateral According to the concept of precision hepatobiliary-pancreatic surgery, we paid special attention to delicate operation during the surgery, carefully detaching the tumor and lymph nodes from the mesenteric artery, left gastric artery, common hepatic artery, and intrinsic hepatic artery intact, while performing peripancreatic nerve dissection, anatomical group 7, 8, 9, 12, 13, 14, 15 and 16 lymph node dissection. This resulted in complete resection of the tumor and reconstruction of the patient’s digestive tract. The operation took about 5 hours in total, with intraoperative bleeding <500 ml. Due to the patient's preoperative anemia, 400 ml of blood was transfused during the operation, and the patient returned to the ward safely at the end of the operation. After the operation, the medical and nursing team, considering the patient's advanced age and poor physical condition, under the guidance of the concept of precise hepatobiliary and pancreatic surgery and the concept of rapid rehabilitation surgery, provided early nutritional support, reasonable use of antimicrobial agents, appropriately removed the drainage tube early and encouraged the patient to get out of bed as early as possible. For patients undergoing pancreaticoduodenectomy, the incidence of pancreatic leakage is very high because the tumor at the head of the pancreas is removed and the pancreatic stump and jejunal anastomosis are 2 organs of completely different origins that are rigidly reconstructed and sutured together by manual methods. The pancreatic fluid secreted by the pancreas is the most digestible digestive fluid in the human body, and once it leaks into the abdominal cavity it can seriously corrode the anastomosis, causing serious consequences such as fluid accumulation in the abdominal cavity and abdominal infection. In addition, the common hepatic duct-jejunum anastomosis also has the possibility of serious complications such as bile leak. Through delicate intraoperative hemostasis of the pancreatic remnant and meticulous suturing with 6-0 Prolene sutures thinner than a hair, as well as excellent postoperative monitoring by the medical and nursing team and the patient's family, the patient did not have any complications such as fever, infection, pancreatic leak or bile leak, and was discharged from the hospital two weeks after the surgery. The patient recovered well at the follow-up visit in one month after surgery. The postoperative pathology report showed that the tumor size was 8*5*2.5cm, grade II adenocarcinoma with mucinous adenocarcinoma component, and no cancer involvement was seen in the cut end of stomach, cut end of duodenum, cut edge of pancreas and common bile duct. This case is an example of applying the concepts of precision hepatobiliary and pancreatic surgery and rapid recovery surgery to a real case. In the face of patients with severe disease, advanced age, extremely poor physical condition and high surgical risk, we need precise preoperative evaluation, precise surgical planning, delicate surgical operation and excellent postoperative care to obtain the best organ function protection with the least trauma and thus achieve the best recovery.