Colorectal cancer (CRC) is the most prevalent tumor, with the majority of patients older than 65 years, more than half of whom are older than 70 years, and a quarter older than 80 years. As life expectancy increases, oncologists need to deal with an increasing number of elderly patients. Older patients have more complications, more medications, poorer physical reserve, less access to radical surgery and adjuvant therapy, and there are no guidelines related to the treatment of older CRC patients. Geriatric colorectal cancer is not usually included in clinical trials, so the effectiveness of surgery versus adjuvant therapy for geriatric colorectal cancer is unclear. Dr. Sun of Sweden published an article in Medicine (Baltimore) examining the effectiveness of surgery versus adjuvant therapy for colorectal cancer in older adults >70 years of age. The prospective evaluation was from a Swedish database of 1021 patients with stage I, II, and III colorectal cancer, all of whom underwent radical surgery and some of whom received chemoradiotherapy. 467 had colon cancer, 264 less than 70 years old, 162 70-80 years old, and 123 greater than 80 years old. There were 554 rectal cancers, 264 were less than 70 years old, 234 were 70-80 years old, and 56 were older than 80 years old. Concomitant diseases were higher in elderly patients than in younger patients, postoperative comorbidities and 30-day mortality in elderly patients with colon cancer were similar to those in the younger group, and 30-day mortality in patients with rectal cancer older than 80 years was higher than in younger patients. Adjuvant chemotherapy reduced OS in stage II elderly patients and had no effect on OS in stage III patients, regardless of whether it was colon or rectal cancer. In elderly colorectal cancer patients, adjuvant chemotherapy is a poor OS factor. Short-term preoperative radiotherapy improved OS and local control in elderly patients with stage III rectal cancer and was not effective in stage II patients. Radiotherapy is a favorable factor for elderly patients with rectal cancer. The safety of surgery in elderly colorectal cancer patients is similar to that in younger people, with only higher mortality in elderly rectal cancers older than 80 years. Adjuvant 5FU-based chemotherapy is not beneficial in elderly CRC, and neoadjuvant radiotherapy improves the prognosis of elderly stage III rectal cancer. The results of studies on the suitability of elderly people for radical surgery and adjuvant therapy are often conflicting, and the results of this study showed that although there were more comorbidities, complications and mortality did not differ significantly between the elderly and younger groups, except for rectal cancer patients older than 80 years. Therefore, radical surgery is safe in this group of patients without much consideration of preoperative comorbidities. The survival of elderly CRC patients undergoing surgery is not clear. The results of previous studies continue to be contradictory and have many study flaws. The present study shows that age is not an independent prognostic factor for OS, and the results support that elderly patients can benefit from radical surgery without having to consider preoperative comorbidities. The benefits and risks of 5FU- based chemotherapy in elderly CRC are clear, regardless of colon or rectal cancer, and adjuvant chemotherapy reduces OS in elderly patients with stage II and has no effect on OS in stage III patients. In elderly colorectal cancer patients, adjuvant chemotherapy is a poor OS factor. The results of previous studies are somewhat consistent with the present study and some are different. Whether FOLFOX, the standard of care for stage III CRC in current practice, is beneficial for elderly patients remains controversial. The FOLFOX regimen may be more appropriate for patients with poor prognosis, but the patients in this study were treated with only 5FU + folic acid, which may have influenced survival. Randomized trials have confirmed that neoadjuvant radiotherapy combined with radical surgery is the standard of care for stage III rectal cancer, but whether elderly patients benefit is unclear, and previous studies continue to have conflicting results, but in the present study short-course neoadjuvant radiotherapy was safe and beneficial for stage III elderly rectal cancer, and not for stage II rectal cancer. The current study still has many shortcomings, such as not studying the effects of long-course radiotherapy and other standard adjuvant treatment options in elderly CRC patients. These shortcomings directly affect the direct application of the findings of this paper to clinical practice.