Objective To evaluate the efficacy, safety and survival influencing factors of focused ultrasound ablation (FUA) in elderly patients with advanced pancreatic cancer (aged more than 60 years). Methods Clinical data of the patients over 60 years old with advanced pancreatic cancer admitted in Affiliated Hospital to Academy of Military Medical Sciences from September 2010 to September 2015 were retrospectively collected and analyzed. They were all treated with a JC high intensity focused ultrasound (HIFU) system. The local ablation efficacy, pain relief and occurrence of complications were evaluated. The overall survival rate (OSR) and median survival time (MST) were statistically analyzed. The main factors affecting MST were analyzed. Results The obtained 44 patients received totally 47 treatments of FUA. The patients who achieved complete response (CR) accounted for 6.8% (3/44), partial response (PR) for 77.2% (34/44), stable condition (SD) for 13.6% (6/44), and progress condition (PD) for 2.3% (1/44). The pain relief rate was 97.4% (38/39), with the pain scores decreased significantly postoperatively (P<0.001). For the patients with stage Ⅲ and Ⅳ pancreatic cancer, the MST were 16.5 (6.1-51) and 9.8 (3-24.4) months, and the 1-and 2-year cumulative survival rates were 62.9% and 21.0%, and 39.1% and 4.3%, respectively. The overall incidence of complications was 50.0% (22/44), among which 95.5% (21/22) were mild complications, and no severe complication was seen. Cox multivariate analysis indicated that the main factors affecting prognosis were clinical stage, ablation efficacy and combination treatment. The MST reached to 24.2 months in the patients with stage Ⅲ who combined chemotherapy and radiotherapy. Conclusion FUA is a good option for advanced pancreatic cancer in the elderly patients, with better efficacy of local ablation, obvious pain relief, and prolonged survival time. The complications can be controlled. It is worth of further study.