With the growth of the aging population, the number of elderly lung cancer patients has increased significantly, and surgery has gradually become a routine treatment for elderly patients (especially those over 75 years old) with lung cancer. The indications for surgery and postoperative perioperative management of elderly lung cancer patients have been a hot issue for research. In this paper, we reviewed 62 lung cancer patients over 75 years of age who were treated surgically in our hospital between January 2004 and December 2007, and discussed the postoperative perioperative monitoring and management of elderly lung cancer patients. Su Lei, Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University In recent years, the incidence of tumors in the elderly has also been increasing significantly. In our group of 62 cases, the average age was 78.4 years, accounting for 47.6% of the total number of lung cancer patients operated during the same period. The elderly not only have degenerative changes in tissues and cells (including alveolar degeneration, reduction of alveolar active substances, and degeneration of respiratory and skeletal muscles), but also have a greater proportion of comorbidities such as arteriosclerosis, coronary heart disease, hypertension, chronic bronchitis, diabetes mellitus, and cerebrovascular diseases than the young and middle-aged patients. In this group, the incidence of perioperative complications was 56.45%, and the mortality rate was 0.16%. During the same period, 9 cases (14.5%) had pulmonary complications such as atelectasis, pneumonia and pulmonary insufficiency, and 4 cases had type I respiratory failure, all of which were ventilated by tracheotomy and ventilator-assisted breathing, 1 case died, and the remaining 3 cases were in remission after treatment, The greater the extent of lung resection, the greater the impact on lung function. If not handled properly, it may lead to respiratory insufficiency or even failure, and respiratory failure is the biggest and most direct risk factor causing death in elderly patients with lung cancer. The most common complication in this group was arrhythmia (35.5%) with atrial fibrillation and premature atrial beats as the main manifestations. Hypoxia due to anesthesia and surgery is a common cause of postoperative arrhythmias. It has been reported that supraventricular tachycardia, atrial premature beats, ventricular premature beats, and even heart failure often occur due to hypoxia and overdose of fluids. In addition, fear, hyperthermia and pain also cause sinus tachycardia. Therefore, continuous postoperative monitoring of cardiopulmonary function, adjustment of infusion rate, oxygenation and function, timely detection of arrhythmias and pharmacological treatment can greatly reduce arrhythmias and more serious complications. In the literature, high complication rates and high operative mortality are the clinical characteristics of surgery in elderly patients with lung cancer. However, surgery is still the most effective treatment for elderly lung cancer patients. The patient’s age is not an absolute contraindication to surgery, but we should understand the physiopathological characteristics of elderly patients and make a comprehensive and scientific evaluation of objective examination indexes, including cardiopulmonary function. Preoperative preparation should be done, including strict smoking cessation, respiratory preparation, respiratory function exercise and oral hygiene to enhance lung function and improve resistance to infection. For patients with obvious respiratory tract infection, broad-spectrum antibiotics should be given intravenously before surgery to prevent postoperative infection. In patients with cardiac insufficiency, myocardial nutrition should be improved and myocardial stress capacity should be enhanced. Those with hypertension should have appropriate blood pressure control before surgery. Strengthening perioperative monitoring and management is an important part of reducing the risk of surgery for elderly lung cancer patients. We emphasize “individualized treatment” and select the scope and mode of surgical resection suitable for elderly lung cancer patients, strictly according to the principle of “two maximums”, i.e., maximum removal of tumor and maximum preservation of lung tissue. Lobectomy/segmental lung resection should be chosen as much as possible, and total lung resection should be avoided as much as possible. Statistics show that after lobectomy, FVC and maximum ventilation volume (MVV) were reduced by 11.12% and 11.16%, respectively, and after total lung resection, FVC and MVV were reduced by 23.11% and 11.16%, respectively. In this group, lobar/pulmonary segment and total pneumonectomy accounted for 87.1% and 0.97% of the cases, respectively. Wedge resection of lung cancer lesions has been controversial. Lung wedge resection is not the standard treatment for lung cancer, but in elderly patients, especially those with cardiopulmonary insufficiency, the choice of television-assisted thoracoscopic surgery (VATS) lung wedge resection not only resects the primary lesion, but also preserves the maximum lung function and lays the foundation for future adjuvant therapy, which is beneficial for prolonging survival. In contrast, total pneumonectomy is indisputably considered to be a prudent procedure. In conclusion, although elderly lung cancer patients have more concurrent diseases, as long as sufficient attention is paid to the preoperative preparation, selection of appropriate surgical procedures and strengthening postoperative monitoring and management, with special emphasis on the monitoring and treatment of cardiopulmonary insufficiency, the occurrence of perioperative complications can be largely reduced and prevented, the risk of surgery can be reduced, and a good foundation for comprehensive treatment can be laid. This article is authorized by Dr. Lei Su.