[Specificities of oncologic surgery in elder patients]

The demographic aging and the perpetual increase of cancer incidence in the elderly emphasize the importance of diagnostic and therapeutic specificities within this population. Understanding the concept of frailty, a potentially reversible process altering homeostasis, becomes crucial for their management. When diagnosing a localized cancer in an elderly and comorbid patient, the decision for surgical treatment must be collegially discussed after thorough geriatric and anesthetic evaluations. Less invasive alternatives will be systematically explored, in particular organ-sparing strategies. If surgery is fully advocated, the perioperative period must be optimized by the inclusion of patients in Enhanced Recovery After Surgery (ERAS) protocols. Anyhow, chonological age alone should not compromise the principles of oncological surgery but rather encourage an individual-based approach, adapted to patients' physiologies.The particularities of oncological surgery in elderly patients are illustrated here by the example of a bladder tumour infiltrating the muscle.