The incidence of gastric cancer (GC) peaks in elderly and senile ages, so the possibilities of adequate surgical treatment in these patients are limited by concurrent cardiovascular and respiratory diseases, diabetes, and chronic gastrointestinal diseases. The risk of intra- and postoperative complications is particularly high in uncompensated comorbidity. Objective — to perioperatively assess functional status and operative risk in elderly patients with GC. Subject and methods. At the perioperative stage, the investigators studied the clinical data of 82 senile patients (older than 75 years) with gastric malignant tumors according to the WHO classification. The patients included 43 men and 39 women. Their age was 75-85 years (mean age, 78.7 years). Their functional status was evaluated using physical examination, general clinical and biochemical laboratory parameters, ECG, echocardiography, and, if necessary, 24-hour Holter ECG monitoring; external respiratory function parameters were studied when planning a combined access; physical condition was evaluated according to the ECOG-WHO scale (0—4 scores), and operative and anesthetic risks were assessed by ASA (scores I to V. Results. ASA I—II (a compensated systemic disease) was recorded in 24 (29.2%) patients; ASA III—IV (a serious systemic disease) in 57 (69.6%) patients, ASA V (an extremely high risk for a poor outcome) in 1 (1.2%) patient. To assess the patients’ general condition, the investigators used the ECOG scale: 0—2 scores in 75 (91.5%) and 3 scores in 7 (8.5%). Surgical treatment could not be performed in patients having an ECOG score of 4. Postoperative surgical and therapeutic complications were observed in 16 and 28 patients, respectively; there were a total of 44 (53.6%) complications, which is slightly higher than the relative average annual complication and death rates. It was noted that 98% of all complications and 100% of fatal complications were diagnosed in patients with preoperative ASA III—V. There was one surgical complication.in patients with ASA I—II. The whole group had the following complications according to the Clavien—Dindo classification: I in 11 (25%), II in 5 (11.1%), III in 15 (34.09%) (IIIa in 12 (27.3.5%), IIIb in 3 (6.8%), IV in 9 (20.4%), and V in 4 (9.1%). In 3 patients, postoperative death was associated with acute cardiovascular and respiratory failure; one patient with arrosive intra-abdominal bleeding developed asystole followed by cardiopulmonary failure and death. The overall mortality rate in the examined group was 4.9%. Conclusion. The algorithm for perioperative functional status assessment in elderly patients with gastric cancer involves comprehensive examination and a detailed assessment of risk factors, which will be able to subsequently work out an individual perioperative management program for elderly patients and to reduce the risk of postoperative complications and death associated mainly with comorbidity in elderly patients.