Background Radical lung resection is the best chance for cure in patients with anatomically resectable non-small cell lung cancer.A retrospective study was performed in an attempt to investigate general rules of major lung resection for non-small cell lung cancer in patients with compromised pulmonary function.Methods Between June 2002 and December 2008,major lung resection was performed in 127 non-small cell lung cancer patients at our institution,who met the criteria of compromised pulmonary function defined as preoperative forced vital capacity ＜50％ of prediction or preoperative forced expiratory volume in one second ＜50％ of prediction.Clinical data of the patients were retrospectively reviewed.Results The patients consisted of 108 males (85.0％) and 19 females (15.0％) with a mean age of 61.7 years.The morbidity rate was 44.1％ (56/127) and the mortality rate was 4.7％ (6/127).Multivariate analysis identified PaCO2 (P=0.023,OR=2.959,95％ C/ 1.164-7.522),the percent predicted postoperative diffusing capacity of the lung for carbon monoxide (P=0.001,OR=0.176,95％ C/ 0.064-0.480) and comprehensive preoperative preparation (P=0.048,OR=0.417,95％ C/ 0.176-0.993) as the independent predictors of postoperative cardiopuimonary complications that were found in 45 cases.Overall 1-,3- and 5-year survival rates were 90％,55％ and 37％ respectively.For overall survival,multivariate analysis revealed that TNM staging (P=0.004,OR=1.585,95％ C/ 1.154-2.178) was the only independent prognostic factor.Conclusions On the premise of integrated preoperative evaluation and comprehensive preoperative preparation,major lung resection provides an optimal therapeutic for selected non-small cell lung cancer patients with compromised pulmonary function.Hypercapnea and the percent predicted postoperative diffusing capacity of the lung for carbon monoxide ＜40％ could be considered as the independent predictive factors for operative risk in those patients.Chin Med J 2012;125(19):3465-3471