In accordance with the aging of the German population an increasing number of surgical procedures are performed on patients of advanced age. Perioperative data from 441 patients (223 women, 218 men, mean age 64.1 +/- 11.7 years) undergoing colorectal carcinoma resection 133 were aged 70 years and older, 308 were younger than 70 years-were prospectively recorded. Risk factors were found more frequently in the elderly (hypertonus 49% vs. 34%; coronary artery disease 18% vs. 8%; pulmonary disease 39% vs. 31%, gastrointestinal disease 30% vs. 23%). No differences were found in operative (loss of blood, duration of operation, ventilation) and postoperative parameters (intensive care, hospitalization) neither age dependent nor between elective and emergency surgery. Postoperative complications in electively treated patients, such as pneumonia, wound infection, urinary tract infection, pulmonary complications, and anastomotic leakages were not age dependent. Although cardial complications were recorded five times as often in electively treated elderly patients perioperative mortality was unchanged (0.8% vs. 0.9%). After emergency operations the rate of anastomotic leakage after perforating peritonitis was increased in the elderly (5.5%). In particular, cardial complications during emergency surgery in 50% of the elderly had a causal connection with perioperative mortality that was substantially increased by up to 28.6%.