Over the last half of the 20 th century, 80 was often used as an age cut off, for very major surgery, such as oesophagectomy. However, society is changing and people now, not only live longer,but often are also fitter to a greater age . So we often see patients in their 80’s and 90’s who seem biologically much younger. So the question we need to ask is, should we have a different approach to these patients compared to our younger patients? As a general rule in younger patients our approach is often quite standardized . For example, if a patient has an operable oesophageal cancer the approach will be neoadjuvant therapy followed by surgery.In the older patient, howeve, the approach needs to be much more individualized and we need to ask ourselves several questions which don’t usually arise in the younger patient. First, what would be the life expectancy of the patient in the absence of the problem? Second, What is the
likelihood that the procedure ,per se, ( i.e.without any complications), might kill the patient? And third, could a lesser procedure address the problem with similar effectiveness,even if associated with a lower cure rate? In conclusion, I think the major difference in approaching older compared to younger patients with cancer, in considering major surgery, lies in much greater individualization for the older patient.