OBJECTIVE The incidence of colorectal cancer is increasing, mainly due to the aging of the population. Frailty, describing a state of increased vulnerability, is common in older patients, but frailty and high age are not necessarily contraindications to surgical treatment. However, limited data describing long-term outcomes after surgery in this patient group exist. In this clinical follow-up study, we aimed to examine long-term health-related quality of life in older surgical patients with colorectal cancer. MATERIALS AND METHODS Patients were recruited from a prospective multicenter study investigating frailty as a predictor of postoperative complications after surgery for colorectal cancer. A preoperative geriatric assessment was performed, and patients were classified as frail or non-frail. Patients responded to version 3.0 of The European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire-C30 before surgery, 3months postoperatively and at a long-term follow-up 16-28months (median 22months) after surgery. One-way repeated-measures analyses of variance were performed to examine changes in scores over time. RESULTS 180 patients with a mean age of 80years were included at baseline, 138 at 3months postoperatively, and 84 patients (69% of survivors) at long-term follow-up. A significant improvement in quality of life-scores was present 3months after surgery, also in the subgroup of frail patients. At long-term follow-up, scores decreased, but to values above baseline. CONCLUSION Health-related quality of life may be improved in older patients after surgery for colorectal cancer, even in patients who are classified as frail preoperatively.