Background: Pancreatic surgery is still associated with significant morbidity. In a simultaneously increasingly ageing population with elevated morbidity, the risk stratification and indications for surgery are of particular importance. Objective: Assessment of the impact of multimorbidity of patients on the postoperative outcome after pancreatic surgery. Material and methods: Evaluation and summary of the available literature. Results: The postoperative morbidity after pancreatic surgery remains high. Relevant comorbidities, such as liver cirrhosis, cardiac and pulmonary diseases and advanced renal insufficiency enormously increase the risk of perioperative morbidity and mortality; however, in high-volume centers with appropriate expertise in pancreatic surgery the mortality is below 5%. Conclusion: Pancreatic surgery with severe comorbidity can be safely performed in centers with proven expertise. Nevertheless, a careful interpretation of the indications and good patient selection are essential for the postoperative outcome.