Fifty-one men and 7 women greater than 70 years of age (mean 72.3) underwent pulmonary resection over a 5-year period. Fifty-two of these patients had a malignancy, of which 48 were primary lung neoplasms, including 42 cases of non-small-cell lung cancer. The overall operative mortality rate was 10.3%. Mortality was correlated with several preoperative factors, including pulmonary function tests, arterial blood gas tension, age, extent of surgery, stage of disease, and additional systemic diseases. Only the extent of surgery (mortality of 36.4% for pneumonectomies compared with 4.3% for less extensive resections, P less than 0.01) and FEV1/VC (the ratio of forced expiratory volume in 1 sec to vital capacity) (P less than 0.05) had statistical significance. The 5-year survival rate for patients with primary lung malignancies was 40%. In view of the aggressive nature of lung tumors in any age-group, the life expectancy of greater than 10 years at age 70, and the reasonable operative risk compared with the high mortality rate in patients not operated upon, we advocate surgical treatment for most patients greater than 70 years of age with a curable disease.