Objective To explore the surgical procedure and prognosis for elderly patients with early stage non-small-cell lung carcinoma (NSCLC). Methods The clinical data of 113 elderly patients with early stage NSCLC, who were treated in Changhai Hospital between January 2010 and December 2012, were retrospectively analyzed. The clinical features, treatments, surgical approaches, surgical procedures, and surgical outcomes were analyzed. Results Sixty-four patients received surgical treatment and others were transferred to internal treatment. There were significant differences in performance status (PS) and lung function (FEV1% and VC%) between the surgical patients and non-surgical patients (P=0.001, P=0.046, P=0.038). Of the 64 patients undergoing surgical treatment, 47 (73.4%) received video-assisted thoracic surgery (VATS) and 17 (26.6%) received open thoractomy. Fifty-six patients underwent lobectomy, 8 underwent limited resection, and none had pneumonectomy. Among VATS patients, two (4.0%) of the 47 patients were converted to thoractomy. The overall complication rate was 18.8% (12/64), the complication rate of the VATS group was significantly different from that of thoractomy group (6.0% vs 41.0%, P<0.05). Univariate and multivariate logistic regression analysis revealed that conventional open chest surgery was the independent risk factor for post-surgical complications in elderly NSCLC patients (P=0.01,P=0.03). Only one patient died after surgery. Conclusion Elderly NSCLC patients should not be denied for pulmonary resection if their performance status and lung function allow. VATS approach lobectomy can effectively reduce post-operation complications and decrease perioperative risks. Conversion to an open procedure should be considered in case of lymph node adhesions. Pneumonectomy should be avoided for elderly NSCLC patients.