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Introduction: Colorectal Surgery (CRS) for elderly patients represents a challenge. The aim of this study was to assess the impact of age on short-term outcomes after CRS. Methods: One-hundred consecutive octogenarians (group A) underwent CRS between 06/03 and 09/10. Data were prospectively collected and entered in a database. Comorbidities were quantified using the Charlson Comorbidity Index and ASA classification. Outcome measures were postoperative complications (within 30 days after surgery) and 30-day mortality rates. These results were compared to a cohort of 100 patients <80 years (group B) well-matched for ASA score, Charlson Comorbidity Index, and type of surgery. Results: The mean age in group A was 85 years (range: 80-104; 63F; 37M) and 55 years in group B (range 13-79; 46F; 54M). Elective surgery was similar between the two groups (63% vs. 52%) as well as the choice of laparoscopic approach (12% vs. 31%). Surgery for malignant disease was 56% in group A and 58% in group B. The mean Charlson co-morbidity index rate was 0.6% in octogenarians and 0.3% in control group (p=0.03). ASA >III was similar between the two groups (24% vs. 16%, NS). Overall complication rate was 27%, being 28% for group A and 26% group B (NS). Twenty-eight octegenarians patients between group experienced short-term complications after surgery, 4 (14%) of them requiring additional surgery; in this group 18% had Charlson comorbidity index >/= 2 and 36% were ASA III or more. Twenty-six patients in group B experienced short term complications, 5 of them (19%) requiring additional surgery; in this group 8% had Charlson comorbidity index >/=2 and 23% were classified ASA III and above. No differences were observed in terms of postoperative complications between emergency and elective surgery,and laparoscopic versus open.Postoperative (30-day) mortality rate was 2% in octogenarians vs 0% in control group (NS). The average length of hospital stay was 13 days (range: 5-41 days) in group A vs 13 days (range: 4-31 days) in group B (NS)Conclusions: The relation between age and outcomes after CRS is complex and may be confounded by differences in pre-existing comorbidities, different kind of diseases, urgency of surgery and type of treatment received. According to our results there was no difference in the outcome in the two groups. Age is not correlated with postoperative complications and it is not an independent predictor of morbidity and mortality in CRS. Octagenarians undergoing CRS have an acceptable perioperative morbidity and mortality rate and survival rate, and should not be denied surgery based on age alone. Comorbidity index scores and ASA scores are useful tools to identify poor risk patients. Nevertheless this surgery in elderly patients should be performed by experienced surgeons in specialized centers to keep postoperative risk to a minimum.

	Post-operative complications in >80	Post-operative complications in <80	P value
Open surgery	28%	32%	NS
LPS	25%	13%	NS
ASA >/= III	42%	37.5%	NS
Comorbility index v>/=2	33%	22%	NS
Gender	M27% F 28.5%	M 30% F 22%	NS
BMI >/= 25	50%	33%	NS
Surgery duration >/= 180 min	54%	30%	NS
Elective surgery	32%	23%	NS
Emergency surgery	22%	29%	NS
Previous surgery	44%	26%	NS
LPS converted patients	50%	0%	NS
Malignant disease	34%	27.5%	NS
Benign disease	20%	24%	NS