Objective – to identify risk factors for postoperative complications and 30-day mortality in patients with central non-small cell lung cancer undergoing anatomical lung resections. This retrospective single-center study included 146 patients with central non-small cell lung cancer selected from a cohort of 509 patients who underwent anatomical lung resections between 2014 and 2025. Tumors were classified as central when located in the main, intermediate, lobar, or segmental bronchi. Clinical and demographic characteristics, pulmonary function parameters, clinicopathological tu-mor features, intraoperative variables, and postoperative laboratory data were analyzed. Postoperative complications were classified according to the modified Clavien – Dindo classification. Univariate and multivariate logistic regression analyses were performed to identify risk factors. Postoperative complications occurred in 68 of 146 patients (47 %). Minor complications (Clavien – Dindo grades I–IIIa) were observed in 54 patients (37 %), while major complications (grades IIIb–V) occurred in 14 patients (10 %). The 30-day mortality rate was 6 % (eight cases). In univariate analysis, the risk of postoperative complications was associated with the Charlson Comorbidity Index (OR 1.17; 95 % CI 1.00–1.38; p = 0.047), complicated tumor course (OR 2.12; 95 % CI 1.08–4.17; p = 0.029), presence of pulmonary hemorrhage (OR 2.43; 95 % CI 1.06–5.56; p = 0.036), emphysematous changes in the lung parenchyma (OR 3.29; 95 % CI 1.63–6.65; p = 0.001), and postoperative decrease in total protein levels (OR 1.05; 95 % CI 1.00–1.10; p = 0.041). In multivariate analysis, emphysema was the only independent predictor of postoperative complications (OR 3.03; 95 % CI 1.43–6.44; p = 0.004). Increased 30-day mortality was associated with impaired pulmonary function (categorical FEV₁, vital capacity, and predicted postoperative FEV₁) and greater intraoperative blood loss. Patients with central non-small cell lung cancer represent a clinically more complex group characterized by technically demanding surgical procedures and a higher risk of adverse postoperative outcomes. Emphysematous changes in the lung parenchyma are the most significant independent predictor of postoperative complications. Reduced pulmonary function and increased intraoperative blood loss are associated with higher 30-day mortality. Comprehensive assessment of clinical, functional, and intraoperative parameters allows for more accurate risk stratification and optimization of perioperative management in this patient population.