To clarify the feasibility of lung resections, especially those with video-assisted thoracoscopic surgery (VATS), for elderly patients with primary non-small cell lung cancer, 14 patients aged 80 to 83 years who had undergone surgical treatment at Tohoku University Hospital from 1997 to 2004 were retrospectively reviewed. Thirteen of 14 patients had clinical stage I lung cancer and VATS lobectomy was applied to 7 of 9 patients undergoing VATS. One hospital death with acute exacerbation of interstitial pneumonia was recorded in a patient undergoing standard thoracotomy because of severe pleural adhesion. Overall 5-year survival rates of these 13 patients were 63.3% and those with VATS lobectomy were 66.7%. We conclude that VATS lobectomy is a feasible therapeutic option to be offered to selected elderly patients with clinical stage I lung cancer.