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With the aging of the population, the proportion of elderly lung cancer is increasing. More than ten years, lobectomy with mediastinal lymph node dissection has been the standard surgery for stage I non-small cell lung cancer (NSCLC). However, recent studies found that sublobectomy could get the same long-term outcome with the lobectomy for elderly clinical stage I NSCLC and more normal lung tissue could be retained. It becomes controversial again about the standard surgery of stage I NSCLC at present. Elderly stage I NSCLC is a special group, who often can not tolerate thoracotomy because of the poor body function and some comorbidities, but the thoracoscopic surgery and the stereotactic radiotherapy technology (STRT) supply them more options. The treatment of eldly stage I NSCLC is developing towards to the individualization and diversification.