[Surgical treatment of elderly patients with cancer]

Surgical intervention for elderly cancer patients should be carefully considered after weighing the risks of post-operative mortality, morbidity, functional deterioration due to the surgery, and speculated life expectancy. The decision to perform surgery should be made only after considering the merits and demerits of the surgery compared with other treatment options, and the patients' own opinions based on sufficient understanding of his/her disease. Pre-operative risk assessment is indispensable and should be used to evaluate not only chronological age but also various functional aspects, clinical findings, and social and economic backgrounds. In the literature, several assessment systems have been introduced. However, none of them successfully covered various modes of surgical procedures that have been adopted for a wide variety of cancer diseases and stages. Some of them are not practical because they are extremely time-consuming. Generally, the surgical option is indicated in patients with longer life expectancy, an earlier cancer stage, and lower speculated risk, to realize the cure of the disease. Fundamentally, surgical intervention is aimed at a prolongation of life span with minimum disruption to activities of daily living. From this point of view, conservative options, such as radiation or drug therapy are sometimes preferred over surgery even in cases of earlier stage of cancer. On the other hand, surgical intervention may be appropriate for patients with advanced disease for avoiding urgent life-threatening symptoms or serious functional disorders that annoys patients' daily life.