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Your raise the important issue of when, and by whom, the decision to operate should be made. We had a similar case of a 78-year-old lady who had a delayed diagnosis of superior mesenteric artery thrombosis. Despite the ‘high risk’ of operative mortality, she consented to surgery, offered to her by a specialist registrar, after a telephone conversation with the consultant. She requested that we withhold her decision, and the potential adverse outcome of this, from her husband, also an in-patient at that time. She did not survive surgery. Whilst I accept that percentage risk is not an exact science, it must guide how we select patients for surgery. Chemotherapy is not an option for frail or elderly patients so why do we feel a compulsion to offer surgery to high risk patients? Once this offer is on the table, it is unprofessional and, some would argue, inhumane to subsequently withdraw it with no alternative chance of survival. Let us not forget that we have an equal responsibility to preserve quality of death as we do to quality of life. I am sure that I am not alone in wondering whether your patient survived his recent battle.