With the increase of the average age of the society’s population, the proportion of elderly people among lung cancer patients has been increasing. Patients of advanced age have different degrees of organ function degeneration, more concomitant diseases and relatively higher surgical risks, so the treatment strategy for these patients should be different from that of the relatively younger group, and consideration should be given to eradicating the tumor while preserving as much normal lung tissue as possible to maintain the patient’s postoperative quality of life. No single pulmonary function measurement value should be used as the only indicator to assess the risk of surgery, especially for elderly patients, and should be combined with the disease to make a comprehensive judgment and pay attention to the patient’s exercise tolerance. For patients with tolerable cardiopulmonary function, especially in early cases, standard lobectomy is advocated, while for patients with poorer cardiopulmonary function, partial lung resection is a safe option. Patients with reduced effective gas exchange area, decreased diffusion function, and increased pulmonary artery pressure after total pneumonectomy have higher perioperative complication rates and mortality than lobectomy, therefore total pneumonectomy should be performed with caution in patients over 70 years of age, with bronchial sleeve resection or pulmonary angioplasty to preserve the patient’s normal lung tissue if possible.