Purpose of Review <p>This narrative review explores the evolving role of surgery in older adults with cancer, highlighting non-operative and minimally invasive alternatives, and the integration of geriatric principles to improve selection of treatment and postoperative outcomes.</p> Recent Findings <p>Minimally invasive and non-operative treatments can provide comparable oncological outcomes to traditional surgery with lower morbidity and better functional recovery. Frailty screening tools aid in predicting postoperative outcomes, and geriatric assessment can identify vulnerabilities and assist treatment planning, prehabilitation and rehabilitation. Prehabilitation, early rehabilitation, and multidisciplinary collaboration enhance recovery and align care with patient values and outcomes that matter most.</p> Summary <p>Surgical care in older cancer patients is shifting toward a model focused on preserving quality of life and personalised decision-making. Incorporating geriatric assessments and less invasive approaches can improve outcomes and reduce treatment burden. Further research is needed to integrate these strategies into standard practice.</p>