Objective To explore application value of three ⁃ dimensional reconstruction technology in thoracoscopic radical resection for lung cancer in the elderly patients with lung cancer and tuberculosis. Methods A retrospective analysis was performed on 80 elderly patients with lung cancer and tuberculosis who had undergone thoracoscopic radical resection for lung cancer in our hospital from August 2015 to October 2019. Forty ⁃one patients receiving surgical procedures based on three⁃dimensional reconstruction and virtual surgery were assigned to group A，while another thirty⁃nine patients undergoing routine surgery were assigned to group B. The surgical situation was compared between the two groups. Results The proportions of lobular sign，spinous process sign， vascular convergence sign，short burr sign and pleural depression sign displayed by three⁃dimensional reconstruction imaging were greater than those by axial imaging（P < 0.05）. The accuracy，sensitivity and specificity of three⁃ dimensional reconstruction for determining lymph node metastasis were 87.80%，93.10% and 75.00%，which were higher than those of axial imaging（70.00%，75.00%，and 58.33%）. The surgical duration and postoperative hospital stay were shorter，intraoperative blood loss and postoperative drainage volume were lower，and number of intraoper⁃ ative resected lymph nodes was larger（P < 0.05），and the incidence of complications was lower in group A than in group B（9.76% vs. 26.83%，P < 0.05）. Conclusions Application of three⁃dimensional reconstruction technology in thoracoscopic radical resection for lung cancer in the elderly patients with lung cancer and tuberculosis can effectively provide lesion information，which is beneficial to shortening surgical duration，reducing intraoperative blood loss，and lowering occurrence of postoperative complications.