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To compare the clinical features and the perioperative and long term outcomes afterprimary surgery for colorectal cancer in the elderly population with those observed in younger patients.All the patients over the age of 55 who underwentprimary surgery for colorectal cancer in our clinic from 1988 to 2008 were included in this study and divided into two age groups: 55- 75 years and > 75 years considering the age of diagnosis.Nine hundred and fourteen consecutive patients were enrolled in the study (352 > 75 years). In the elderly group tumours werepredominantly right sided and the number of comorbidities was statistical higher. The overall operative mortality rate was 5.9% in the study group compared with 2.1% in the control group (P = 0.0033). The overall 3-, 5-and 10-year survival rates were respectively 37%,16.2% and 5.1% in the study group, compared with 52.3%,35.1% and 24.7 in the control group. More deaths unrelated to cancer were found in the study group compared with the control group (P = 0.0005). The cancer specific mortality was similar between the two groups.Elderly patients that underwent major colorectal resection have an acceptable perioperative morbidity, mortality and survival rate compared to younger patients. Age alone should not be considered a reason to deny surgery to these patients.