We report here the outcome of surgical treatment for gastric cancer in 54 patients over 80 years of age presenting from 1967 to 1989. The mean observation interval of the postoperative period was 24 days. In most cases, preoperative examinations revealed pulmonary, renal or cardiac disturbances. The postoperative morbidity rate was 40.7%, most commonly as a result of pulmonary complications. In the 2 patients with multiple organ disturbances, 1 died 1 day after operation following myocardial infarction and the other died of pneumonia 12 days postoperatively. Intensive care treatments were needed in the early postoperative period. The increased morbidity rate proved to be related to wide resectional procedures such as total gastrectomy, operative time in excess of 3 hours, and intraoperative blood loss greater than 300 ml (p less than 0.05). When adjustment for confounding variables was made in the multivariate discriminant analysis, the type of surgery proved to be a major independent risk factor related to postoperative complications. The majority of tumors (92.6%) could be removed by standard resectional procedures and curative operation was feasible for 36 (66.7%) patients. There were 24 deaths due to progression of the cancer. The crude overall 5-year actuarial survival rate was 23.8%, while the rate was 36.9% when correction was made for sex and age. The probability of long-term survival for patients in a relatively early stage of disease (T1-2, N0-1) was statistically better than for those with a more advanced disease (T3-4, N2, M1). Thus, even for patients in the 8th decade of life, gastric surgery can be considered, for carefully selected patients.