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This study aimed to identify risk factors for major postoperative complications (TMM) and their impact on overall survival in patients aged ≥80 years undergoing lung cancer surgery, a group at increased risk of morbidity. A total of 88 patients aged ≥80 years who underwent anatomical lung resections were retrospectively analyzed. Postoperative complications were classified into minor or no complications (TMM 0-2) and major (TMM ≥ 3) complications. Logistic regression analysis was performed to identify independent predictors of major complications. Kaplan-Meier estimates were used to measure overall survival. Major complications occurred in 24 patients (27.3%). Multivariable regression analysis identified perioperative blood transfusion as an independent risk factor for major complications (p = 0.0009). Patients with major complications exhibited significantly reduced overall survival (p = 0.0009). Subgroup analysis revealed that patients who underwent minimally invasive surgery had significantly better survival (p = 0.01). Moreover, perioperative transfusion correlated with diminished overall survival (p = 0.0027). In patients aged ≥80 years undergoing lung resections, the occurrence of major postoperative complications is associated with significantly impaired survival. Minimally invasive surgical approaches and blood conservation strategies may mitigate complications and enhance long-term outcomes in this high-risk group.