In our Country 16% of population is over 65 years old and on 2010 a quarter of people will be over 70 years old. More over the percentage of patients over 70 years admitted in surgical departments is triple than 10 years ago and the percentage of octgenarian patients is ten times. In the last years new methods of diagnosis and care have been introduced to reduce morbility and mortality; the preoperative evaluation to define the risk factors is complex. The surgeon should respect some primary points: the patient interest, true surgical treatments, multimodal management, valid pain therapy, discharge as soon as possible, ambulatory or day hospital management, expecting and quality of life.