Surgical treatment of non-small cell lung cancer has been reported to be associated with increased mortality, especially when pneumonectomy has been employed. A 9-year review of 81 patients treated surgically, with a policy of avoiding pneumonectomy and using internal radiation and wedge excisions rather than lobectomy among patients with impaired reserve, resulted in an operative mortality of 4.9% compared with an overall mortality of 2.1%. Three of the four deaths were among patients older than 80 3/17 (17.6%) years so that mortality of patients 70 < age < 80 was not significantly different from overall mortality. Two of the four deaths were related to pulmonary emboli but there have been no such deaths since routine use of mini-heparin was initiated in 1990. Five-year survival was 42% overall, 65% for stage 1, and 24% for stages II-IIIB. We conclude that surgical treatment of patients 70 < age < 80 may be accomplished with similar mortality and survival as the overall population. Heparin prophylaxis may be especially important among patients older than 80 years.