BACKGROUND: To support decisions about surgical treatment of elderly patients with cancer, population-based estimates of postoperative mortality (POM) rates are required. METHODS: Electronic records from the Rotterdam Cancer Registry were retrieved for octogenarians and nonagenarians who underwent resection in the period 1987-2000. POM was defined as death within 30 days of resection and both elective and emergency operations were included. RESULTS: In a series of 5.390 operated patients aged 80 years and older, POM rates were 0.5% for breast cancer, 1.7% for endometrial cancer and 4.2% for renal cancer. For patients with colorectal cancer, POM increased from 8% for the age group 80-84 to 13% for those 85-89 to 20% in nonagenarians. For stomach cancer, the respective figures were 11%, 20% and 44%. CONCLUSION: These results show that resections can be performed at acceptable risk in selected elderly patients with cancer.