We currently performed pancreaticoduodenectomy in two ultra-senior patients. The first patient was a male, 89 years old. Half a month ago, he felt itchy skin, thinking that his skin was dry in winter, and then he applied a lotion to make it ineffective. Later, he developed loss of appetite, wasting, abdominal distension and occasional abdominal pain, followed by yellow sclera staining of the skin, brown urine and white stools. After gastroscopy, the patient was considered to have duodenal papillary cancer. The patient was very old, so either to perform palliative percutaneous liver puncture with long-term external drainage without tumor excision or to perform pancreaticoduodenectomy with tumor excision, which is one of the largest surgical procedures, removing many organs such as gallbladder, bile duct, part of stomach, head of pancreas, duodenum and part of jejunum, and also to perform intestinal and bile duct, pancreatic and gastric anastomosis, which has long operation time, high risk and many complications. After full communication with the family, it was decided to take radical surgery. Adequate preoperative preparation, delicate intraoperative operation, close postoperative monitoring and observation are necessary. For this patient if a little complication occurs, in younger patients there is still a chance to take means to treat again, but for this old gentleman it was a fatal blow. The pressure was on us to make sure that the patient could not develop any complications. At the same time, another 88-year-old gentleman suffered from the same symptoms as this patient, with generalized yellowing of the skin and severe itching of the skin, and was diagnosed with carcinoma of the lower bile duct, also with two options of palliative puncture and radical surgery. The family said the previous patients were one year older and chose radical surgery, so we also chose radical surgery. But we waited a few days to see, and when the family saw that the previous patient was mobile and fluid 5 days after surgery, they asked for radical surgery again, again, we had to make sure that there were no complications. Both elderly had underlying diseases such as pulmonary disorders and hypertension in the former and severe diabetes for many years in the latter. Thankfully, both seniors made it through the surgery and post-operative recovery without any complications and were discharged from the hospital. Throughout their hospitalization, the two seniors were very kind and relaxed.