With the progress and development of society, people’s living health care level has been improved and raised, human life expectancy has also been extended, and now all societies have gradually entered the elderly society. The number of abdominal surgical diseases in the elderly will also increase naturally, but the degenerative changes in organ function and the decline of various physiological reserve functions in the elderly, most of them have multiple coexisting diseases, which makes the surgical treatment of the elderly complicated and dangerous, but as long as the perioperative preparations are done carefully, most patients can still achieve satisfactory results. In the past 2 months, I have operated on 8 cases of radical gastric cancer (3 total gastric, 4 distal gastric and 1 proximal gastrectomy) in elderly and ultra-elderly patients, aged 73-82 years, including 3 males and 5 females. The total number of hospitalization days was 12-18, and the total number of postoperative hospitalization days was 8-14. Preoperative complications were three with one disease, four with two diseases, and one with three diseases, including six patients with hypertension, three with diabetes mellitus, one with renal failure, and four with heart disease. Anesthesia was general with tracheal intubation in all cases. Three cases were admitted to SICU ward after surgery, and two of them applied ventilator-assisted breathing after surgery, and all ventilators were discharged within 24 hours. 8 patients were all discharged cured. There were 2 cases of postoperative complications, including 1 case of pulmonary infection and 1 case of wound infection. It has been proved that for surgical procedures in elderly and ultra-elderly patients, a meticulous and comprehensive preoperative examination is necessary to understand the medical history and to detect hidden coexisting diseases in a timely manner, and to comprehensively assess the reserve function of the patient’s vital organs. We should actively correct coexisting diseases, deal with all kinds of abnormalities, strengthen the regulation of blood pressure, heart, blood sugar, electrolytes and nutrition, control respiratory infections and clean the airways. If necessary, a temporary pacemaker can be installed before surgery for patients with bradycardia. Perfect and effective preoperative preparation can enable elderly and ultra-elderly patients to pass through anesthesia and surgery smoothly and ensure the safety of surgery. The following are some experiences and lessons learned from years of clinical work in the treatment of elderly gastric cancer patients, and some insights into the perioperative period of elderly and ultra-elderly patients. At present, people above 70 years old are considered as senior patients and people above 80 years old are considered as super senior patients. The psychological state of senior patients towards surgical treatment is closely related to the level of education, social interaction, consciousness and family economic status, and the influence of surrounding people. Their psychological states can be summarized as Serious patients who need elective surgery: They have concerns but have a strong desire to treat the disease. They are anxious about surgery, afraid of pain, after-effects, inability to take care of themselves, and dislike of their children. Therefore, they often say, “I would rather die than suffer a knife.” This is a contradictory psychological state of being strongly opposed to surgery and hoping to cure their disease. In the face of these situations, our doctors need to objectively and specifically analyze the condition and the possible changes of surgery and conduct patient guidance, so that their children and their relatives and friends have a more comprehensive and scientific understanding of the disease, and work together to do a good job psychologically to relieve the patient’s worries, so that he or she can happily accept the surgical treatment. 2. long duration of the disease, stubbornly recurrent, non-surgical incurable: these patients are mostly unwilling to operate in the past and These patients, who had been unwilling to undergo surgery in the past, went around and sought medical help everywhere, but to no avail, reluctantly accepted surgery out of reluctance. Since they still have a serious fear of surgery, it is difficult to relieve them temporarily, so we should not simply look at their willingness to undergo surgery from the surface, but also understand their true psychological state. In addition to detailed and in-depth ideological work, we often invite old patients of the same age who have been cured of similar diseases to speak in person, which often plays an unexpected role and can fully mobilize the enthusiasm of patients to cooperate with surgery. 3. chronic diseases with critical complications and urgent surgery: these diseases are often life-threatening, and the pain of the disease has far exceeded the fear of surgical treatment. In terms of attitude, they seem to have made up their mind and will to undergo surgery. However, they still lack proper preparation in their minds. We often prepare for surgery as soon as possible and at the same time combine the solution of ideological problems with the relief of disease pain. 4. Advanced tumor patients who have lost the opportunity of surgery: These patients have a serious psychological “fear of death” and do not understand the extent of their disease and blindly request meaningless surgery. We often praise these patients for their strong will to overcome the disease, and if necessary, verbally satisfy their demands and advise them to enhance nutrition in order to “create” the conditions for surgery, which is a “scientific lie” but can make the patients temporarily free from mental pain. After completing the preoperative psychological reassurance of the patient, the preoperative assessment of the patient’s condition and the extent to which the surgery will hit the patient is also very important. Elderly patients often have many medical comorbidities, the most common of which include diabetes, hypertension, heart disease, respiratory disease, cerebrovascular disease, etc. For patients with these chronic diseases, preoperative treatment in collaboration with relevant departments can help stabilize the patient’s condition intraoperatively and postoperatively. For example, preoperative electrocardiograms of patients over 80 years of age are almost all abnormal, and even if the preoperative electrocardiogram is normal, myocardial ischemia may occur in the perioperative period due to certain conditions. During the perioperative period, cardiac monitoring, adequate sedation, and increased energy reserves can reduce the burden on the heart. Postoperative pulmonary complications are also a common complication in elderly surgical patients, which can easily induce ARDS. strengthen preoperative airway cleaning and respiratory function training, and apply ventilator-assisted breathing for a period of time after surgery as far as possible to facilitate complete metabolism of anesthetics and recovery of autonomic breathing, and reduce energy consumption of the body during respiratory muscle work. Encourage coughing and sputum excretion, give cholinergic antagonists, β-agonists, and a certain amount of adrenocorticotropic hormone nebulizer inhalation to keep the respiratory tract unobstructed, and use appropriate antibiotics if necessary to effectively prevent respiratory tract infection and pulmonary atelectasis and reduce the occurrence of pulmonary complications and respiratory failure after surgery. Also some elderly patients will have symptoms of gastrointestinal bleeding after surgery, which is related to prolonged postoperative fasting, surgical trauma, hypotension, and gastrointestinal mucosal hypoxia. We have learned that early enteral nutrition can help maintain the structural and functional integrity of intestinal mucosa and protect the barrier function of intestinal mucosa, which, together with the application of drugs to prevent stress, can effectively reduce the occurrence of postoperative gastrointestinal bleeding. Nutritional support is also very important for the postoperative recovery of elderly patients, because the tissues of elderly patients are very fragile and the repair ability of the body is poor. The abdominal surgery is very traumatic, with many digestive anastomoses, and there is already liver decompensation and malnutrition, and the routine postoperative fasting also aggravates the malnutrition of patients, thus affecting the recovery of body function and tissue healing after surgery. The early use of the gastrointestinal tract to promote the recovery of gastrointestinal function and rapidly improve the nutritional indexes has obvious effects. Based on years of experience in handling these patients, we believe that perioperative management is as important as surgery. Under the condition of perfect and careful perioperative management, the indication for surgery can be relaxed moderately. As long as the patient’s systemic systems are monitored and managed in a timely and accurate manner, surgical treatment of elderly and ultra-elderly surgical patients can be safe and effective.