The Surgical ad-hoc Committee is an integral part of the SIOG as is surgery an integral part of treatment of senior adults affected by solid malignancies. As surgery is always evolving so is the SAHC, that is constantly looking for and welcoming new members who share the passion for the care of older patients.

The times we are living in will be remembered by healthcare providers for the significant ‘contradictions’ in the medical and surgical care of older patients with cancer. On one hand it has been documented how chronological age per se does not contraindicate surgical management at any time in life; on the other hand the vast majority of senior cancer patients are routinely undertreated as a consequence of unproven assumptions. This group of cancer patients is likely to receive suboptimal treatment, either under-treatment as well as over-treatment. The function of the SAHC is to eliminate the myth that the senior adults are not candidates for surgery and this is to be done within the society and to the rest of the world per se.

The role of the SAHC inside the International Society of Geriatric Oncology is mainly to establish evidence that could help clinicians in being more aware and proactive about several issues.

There is a poor understanding of cancer in older patients. Solid tumors are detrimental at any age as shown for colorectal, breast and pancreatic cancer while surgery is still the number one option to treat solid cancer, above all in senor adults. When appropriately chosen it could be curative or good palliative procedure.

A prejudice about life expectancy is usually preventing cancer specialists whether it be medical, surgical, radiation oncologists or geriatricians to offer the best possible treatment. In the USA a 75-year old male in good health has 18 more years in front of him and 10 years at the age of 82ⁱ. The presence of severe comorbidities shrinks life expectancy to 6 and 2 years respectively, which is still a far longer period when compared to the average overall survival of untreated cancer subtypes.

Even though there is significant education going on among the surgeons there are several among the community who are hesitant to operate on older patients just because of the chronological age. Education is the key and there needs to be a valiant effort on the part of the society to show that there is vast available data demonstrating how fit older individuals can successfully undergo most complex invasive procedures with good quality of life outcomes.

The work of the SAHC began about a decade ago when the PACE studyⁱⁱ proved that the assessment of frailty in every older patients undergoing surgery accurately predicts the operative mortality, morbidity and costs. This was achieved by means of a non-cancer-specific tool (Comprehensive Geriatric Assessment – CGA). In 2014, another SAHC effort, the PREOP studyⁱⁱⁱ, showed that the complex and time consuming CGA, could be replaced by quick and surgeon-friendly tools like the “Timed Up-and-Go” test and how nutrition has to be optimized to minimize complications. Lately, the SAHC together with the European Society of Surgical Oncology (ESSO), developed the GOSAFE study^iv. The research recently completed accrual and will be soon able to provide prospective, original data about quality of life and functional recovery of older patients undergoing major oncological surgery. The ambitious endpoint of this international prospective registry is to take a real-time-picture of the ultimate outcomes achieved when delivering personalized care to fit, vulnerable and frail cancer patients (including cognitive impairment).

The role of the SIOG-SAHC is precisely to promote an individualized surgical standard. We realize that personalized treatment does not stand on targeting molecular biomarkers but on putting real-life patients needs as the ultimate goal of our care.