Abstract: Objective To compare effect difference between thoracoscopic pulmonary segmental resection and segmental resection in the treatment of early non-small cell lung cancer(NSCLC)in elderly patients. Methods The clinical data of 82 elderly patients with early NSCLC who underwent video-assisted thoracoscopic surgery(VATS)in thoracic surgery were retrospectively analyzed. A total of 34 patients with thoracoscopic pulmonary segmentectomy were selected as pulmonary segmentectomy group, and 48 patients with thoracoscopic lobectomy were selected as lobectomy group. The indexes of perioperative period were compared between the two groups, and postoperative follow-up results after 12 months and pulmonary function were compared. Results There were no significant differences in amount of bleeding, the number of lymph node dissection, amount of postoperative drainage, length of hospital stay and cost of hospitalization between the groups(P>0.05). The operation time in the pulmonary segmentectomy group was(170.43±25.90)min, which was longer than(158.70±22.76)min in the lobectomy group(P<0.05); the incidence of operative complications in pulmonary segmentectomy group was 8.82%, which was significantly lower than 12.50% in the lobectomy group, but the difference was not significant(P>0.05). Postoperative 12-month follow-up showed that there were no recurrence, metastasis or death patients in the two groups. However, the decrease rate of forced vital capacity(FVC), forced expiratory volume in one - second(FEV₁), maximal voluntary ventilation(MVV)in the pulmonary segmentectomy group were lower than those in the lobectomy group(P<0.05). Conclusion Thoracoscopic pulmonary segmental resection and lobectomy are both effective and minimally invasive methods in the treatment of early stage NSCLC in the elderly. They have similar short-term effect, but the former has little effect on the pulmonary function, especially for the elderly NSCLC patients with poor pulmonary function or intolerance of lobectomy.