**9. Conclusion**

The aim of surgery for colorectal cancer in the older patient is not only to optimize survival but also the improvement of quality of life and keeping postoperative complications to a minimum. Though some significant differences are present in postoperative morbidity and mortality rates between the young and old, chronological age alone should not be the deciding factor for surgery. Physiological rather than chronological age should determine the management of cancer in each individual, with due regard to comorbid illnesses. Therefore, risk stratification based on comorbidities, and biochemical and physiological markers could help

to decide whether to perform surgery, what type of surgery, and the timing of surgery. Careful preoperative clinical assessment and prehabilitation programs are required in order to optimize outcomes. Laparoscopic surgical techniques should be employed whenever possible. Patients with rectal cancer benefit from transanal endoscopic surgery as a primary procedure or as part of a 'watch and wait' strategy following neoadjuvant chemoradiotherapy. Early elective surgery and the avoidance of emergency major surgery whenever possible, by for example the use of stenting followed by elective resection in cases of colonic obstruction, will help improve outcomes.
