The question of whether major cancer operations are worthwhile in elderly patients is becoming more important, as we are faced with a progressively aging population. From Jan. 1, 1978 to Dec. 31, 1983, 268 elderly patients underwent major operations for esophageal, gastric, intestinal, pancreatic and retroperitoneal cancer. The patients were divided into three age groups: group A, 65 to 74 years (163 patients), group B, 75 to 84 years (81 patients) and group C, 85 to 92 years (24 patients). The overall operative mortality was 11.2%, 8.6% in group A, 13.6% in group B and 20.8% in group C. The higher rates in groups B and C resulted from two major factors: (a) the presence of serious cardiopulmonary disease preoperatively and (b) the development of one or more serious complications postoperatively. When these two factors were compensated for, the rates became comparable at 6.1%, 6.6% and 8.3%, respectively. The effect of preexisting cardiorespiratory compromise was approximately equal in each group. The effect of postoperative surgical complications became more pronounced with advancing age. Most patients enjoyed substantial palliation of symptoms. The average length of hospital stay was not unduly prolonged. Major cancer surgery can be safe and beneficial for elderly patients, but concerted attempts must be made to improve their status preoperatively. The minimum effective operation should be performed and postoperative care should be intensified.