derly people; approximately 60% of patients are aged >70 years at time of diagnosis and 43% of cases are aged >75 years in the western countries [1][2][3] . These proportions will likely continue to increase in the near future, because of the increasing percentage of people living past ninety years, a phenomenon associated with the aging world population.In Italy, according to the Italian National Institute of Statistics (ISTAT) data, the population aged 85 and older will increase from 2.8% in 2011 to 7.8% in 2050, reaching an average life expectancy of 85.3 years for males and 90.5 years for females.This highly significant demographic change in modern society has an important impact on health care, especially in cancer care, as cancer in people aged over 90, poses an ethical dilemma for surgeons and oncologists: non operative management or medical and/or surgical treatment? To treat is an over treatment?In clinical practice, the management of this group of patients is frequently suboptimal, consequently an increasing number of nonagenarian CRC patients are admitted in emergency departments, requiring surgical treatment.Generally, emergency abdominal procedures are associated with increased morbidity and mortality rates, particularly for frail elderly patients. The emergency surgeon often has the crucial role of selecting which patients to submit to surgery, balancing the benefits and the high surgical risk associated with comorbidities.Another important issue to consider is the high costs of the postoperative care for this group of patients which frequently demand rehabilitation and longer recovery, even after minor surgery.We decided to review the recent literature to discuss current strategies in the management of oncogeriatric patients aged over ninety in emergency. MATERIALS AND METHODSWe performed a search by Cochrane Library, MEDLINE, and EMBASE for potentially relevant scientific articles on emergency surgery for colorectal cancer in nonagenarian patients. We considered in our review all the scientific papers published in the last ten years up to June 2015. We included in this study randomized controlled ABSTRACTThe aging of the world population is leading to an increase in the number of patients aged over ninety needing for a surgical treatment in emergency setting. Colorectal cancer in people over 90 years of age represents an ethical dilemma for surgeons and oncologists, above all when the neoplastic disease is advanced and complicated by obstruction and/or perforation. The emergency surgeon often has the crucial role of selecting which patients to submit to surgery, balancing the benefits and the high surgical risk associated with frailty, polipharmacy and comorbidities.We decided to review the recent literature to discuss the latest strate-gies in the management of colorectal cancer in emergency situations, for patients aged over ninety.

stoma creation in comparison with emergency surgery, enhancing patients' quality of life, without differences in terms of mortality and morbidity rate. According to available data, at one year follow up time, the recurrence rate is higher in patients treated with stent, with no statistical difference in terms of disease free survival and overall survival. Endoscopist's experience, type of colic obstruction (partial or total), type of stent, insertion technique and timing of surgery are fundamental to reach CS technical and clinical success. Oncologic (un)-safety of colonic stenting has to be still investigated and confirmed by medium and long term follow up of large prospective studies and randomized controlled trials comparing SEMS as bridge to surgery and ES. CS can be strongly considered with palliative intent in patients with advanced neoplastic disease, to avoid stoma and health care costs related to stoma.