Due to the progress of society and the improvement of people’s living standards, population aging has become a common problem in the world today. The U.S. Census Bureau predicts that by 2030, the number of people over the age of 65 in the United States will double to 70 million, and those over 80 will account for 5.4% of the total population; cancer is the leading cause of death among patients aged 60-80, with the proportion of lung cancer among the elderly increasing year by year. And in China, lung cancer has become the leading cause of cancer death. Geriatric patients have their own physical characteristics: as they age, the incidence of various comorbidities such as coronary heart disease, arrhythmia, chronic obstructive pulmonary disease, diabetes mellitus, etc. increases significantly, which has a negative impact on anesthesia and surgical interventions; the thoracic elastic retraction force decreases, respiratory muscles weaken, chest wall compliance decreases, respiratory effort, and the ventilation response to hypoxia and hypercapnia decreases, resulting in reduced respiratory function. . In addition, Martini et al. reported a significant increase in the likelihood of recurrence of primary lung cancer after primary lung cancer surgery, with the incidence increasing by approximately 3% per year, and patients surviving for more than 5 years are at great risk of recurrence of primary lung cancer. Furthermore, patients may have multiple nodules in one or both lungs, and Henschke et al. reported a 23% incidence of multiple nodules in the lung, 12% of which are malignant. Therefore, it is extremely important for elderly lung cancer patients to undergo lung surgery for the preservation of their normal lung tissue and lung function. Compared with lobectomy, anatomical segmental lung resection can preserve lung function more effectively and reduce perioperative complications, which is especially suitable for elderly patients with early-stage lung cancer. In the last decade, the level of accurate diagnosis and staging of early-stage non-small cell lung cancer (NSCLC) has been greatly improved with the improvement of clinical diagnostic techniques, such as low-dose spiral CT screening, high-resolution CT, CT 3D imaging, PET-CT and the application of mediastinoscopy and ultrasound bronchoscopy (EBUS).Yendamuri et al. SEER) database found that the rate of stage Ia NSCLC as a percentage of primary lung cancer increased from 0.98% in 1998 to 2.2% in 2008. Due to a large number of retrospective studies finding better prognosis for surgery in NSCLC with ≤ 2 cm tumors, the 7th edition of the International Lung Cancer Staging by IASLC in 2007 divided the T1 stage into T1a (≤ 2 cm) and T1b (>2 cm, ≤3 cm). In 2011, IASLC/ATS/ERS introduced a new version of lung adenocarcinoma classification, replacing the original simple bronchoalveolar carcinoma (BAC) with adenocarcinoma in situ (AIS) and replacing the original BAC with focal infiltration with microinvasive adenocarcinoma (MIA) with predominantly squamous growth and infiltrative component less than 5 mm. These two groups of patients have a very low incidence of lymph node metastasis and can achieve near 100% disease-specific survival if they undergo surgical resection. Both AIS and atypical adenomatous hyperplasia (AAH) are included as pre-invasive lesions. Therefore, whether “anatomical segmental lung resection with lymph node dissection” can achieve oncologic requirements for early-stage, low-malignancy lung cancer has become a focus of research. Currently, multicenter, prospective, randomized phase III clinical studies (CALGB 140503, JCOG0802/WJOG4607) are being conducted in the United States and Japan to compare lobectomy and segmental lung resection for stage T1a lung cancer. While lobectomy is currently the “gold standard” for the treatment of early-stage NSCLC, anatomical segmental lung resection has only become a compromise procedure for patients with poor cardiopulmonary function who cannot tolerate lobectomy. Recently, scholars such as Okada, Nomori and Koike from Japan, and D’Amico, Swanson, Schuchert and McKenna from Europe and the United States have conducted a lot of studies and analyses on the use of anatomical segmental lung resection for the treatment of stage T1a NSCLC, and the results showed that the number of lymph node dissection groups and Compared with lobectomy, there is no significant difference in the number of groups and numbers of lymph nodes cleared, recurrence rate and survival rate, and the advantages include fewer postoperative complications, lower mortality rate, and the ability to completely remove the tumor while maximizing the preservation of normal lung tissue, which is especially suitable for elderly patients and those with poor cardiopulmonary function. Compared with open lobectomy, its advantages are: less perioperative bleeding, shorter chest tube placement time and hospital stay, better preservation of pulmonary function, lighter systemic inflammatory response, less impact on the immune function of the body, increased patient tolerance to postoperative chemotherapy, lower complications and mortality, cosmetic requirements, and similar oncological results. similar to each other. Currently, VATS lobectomy has become the standard procedure for the treatment of early-stage NSCLC. Although VATS anatomical segmental lung resection is significantly more difficult and complex than VATS lobectomy, it has the advantages of VATS lobectomy, but it can also maximize the preservation of lung function and is a combination of minimally invasive surgical approach and minimally invasive lung tissue, which can achieve “true minimally invasive”. Combining foreign literature and our experience, the indications for VATS anatomical lobectomy in the treatment of early-stage lung cancer are as follows: 1. clinical stage Ia NSCLC: low malignancy, i.e., GGO ≥ 50%, normal blood tumor indicators CEA, NSE, SCC, CYFRA21-1; 2. history of lung resection or multiple lesions in the lung requiring simultaneous resection; 3. suspected metastatic nodules (2), deep location, adjacent to segmental vessels and segmental bronchi, unable to perform wedge resection; (4), age >75 years, or multiple co-morbidities; (5). Poor cardiopulmonary function, unable to tolerate lobectomy. A total of 122 cases of VATS anatomical lobectomy have been completed at our hospital since September 2010 to date, which has covered all lung segments. Among them, 50 cases of stage Ia NSCLC were treated by VATS anatomical segmental lung resection from September 2010 to November 2012, with an average operative time of 191.5±50.4m, an average intraoperative bleeding of 49.2±54.6ml, an average chest tube drainage of 3±1d, and a postoperative hospital stay of 5±2d. There were 2 cases of postoperative atrial fibrillation and 2 cases of subcutaneous emphysema, and no serious complications such as persistent air leak and hemoptysis There were no serious complications such as persistent air leak and massive hemoptysis, pulmonary torsion, and no surgical death. The average width of the incision margin was 2.2±0.8 cm, and the width of the incision margin was >tumor diameter. The total number of resected lymph nodes was 12.6±2.8 on average, 6.0±1.5 groups, all of which were negative, including 8.4±1.8 N2 lymph nodes on average, 4±1.4 groups. Survival rate was 100%.