In the thoracic surgery clinic, we often encounter such patients with lung cancer who say to the doctor during the consultation, “I have inquired, I don’t want to have surgery, you can prescribe some medicine for me!” When asked why, most of them replied, “My relatives or friends said that XX died soon after the surgery, so it is better not to have the surgery!” It is said that such a view is still relatively common among the masses. Hearing such words, as a lung cancer worker, it is inevitable to have a heavy heart. It is our responsibility to relieve patients’ fears and misunderstandings about surgery and help them choose the best treatment plan. Then, why do people have the notion that “cancer will die faster if you have surgery”? Will surgery really speed up the death of patients and how to properly view the value of surgery in lung cancer treatment? First of all, it is undeniable that in the real clinical practice, the survival time of patients after surgery is not as long as that without surgery. Generally speaking, there are two main reasons for this. First, in terms of surgical techniques, some small hospitals or surgeons with low surgical skills, who are limited by technical ability, responsibility and local hospital equipment during surgical operations, cause such and such operational problems, which may be the main cause or potential hidden danger of intraoperative or postoperative complications. These complications often include intrathoracic hemorrhage, bronchopleural fistula, chest infection, pulmonary atelectasis, lung infection, and respiratory failure. The latter is the main cause of post-operative quality of life and survival of patients. The so-called “death within a few days after surgery” is also often due to this situation. As we all know, the fundamental purpose of surgery is to treat the disease so as to prolong the survival time or improve the quality of life of the patient. For lung cancer patients, the choice of surgery depends not only on whether the tumor can be cut down, but also on whether the tumor has local or distant metastases and whether the patient’s physical condition can tolerate the surgery. In this regard, there is a unified standardized requirement in the international lung cancer treatment principles. However, in reality, some units or clinicians do not follow such standardized requirements in selecting the indications for lung cancer surgery due to the limitation of theoretical level or other reasons. They often think that as long as the tumor can be cut down, it is an indication for surgery. Even during surgery, when tumor invasion is found to be beyond preoperative estimation, they do not decisively adopt a more palliative surgical approach, but are bent on expanding the resection scope indefinitely. Surgery is done simply for the sake of doing surgery. The result of this is that the patient’s postoperative survival time is shortened rather than prolonged, and the quality of survival is greatly reduced. However, both domestic and international lung cancer clinical practice shows that the 5-year survival rate of stage I (early stage) lung cancer patients can reach 70%-80% if they undergo standardized surgical treatment. In contrast, a set of data on the natural course of lung cancer shows that without any treatment, the 5-year survival rate of lung cancer patients with this stage is only 7.5%. Such a disparity speaks volumes about the important value of surgery in the treatment of lung cancer. Obviously, it is not what people think – lung cancer surgery instead makes patients die faster. In fact, despite the rapid development of modern science and technology, surgery is still the primary treatment for lung cancer. The key to this is not whether surgery is chosen for treatment, but whether the best time for surgery is chosen and whether the right surgery is performed on the right patient. Not all lung cancer patients are suitable for surgical treatment. Statistics show that more than 70% of lung cancer patients have already lost the chance of surgery when they visit the doctor. In other words, if we insist on surgical treatment for these advanced patients, the result is bound to be “faster death”. If surgery may hasten the death of a patient, it is because it is performed on a patient who is not suitable for surgery. In addition, for patients with specific stages of lung cancer (e.g., stage IIIa), although surgery may also prolong survival, a combination of preoperative neoadjuvant chemotherapy and surgical resection may improve the 5-year survival rate by 10-20%. For this group of patients, it would clearly be uneconomical to opt for surgery at the outset. This shows that the treatment of lung cancer is not simply a question of whether to operate or not to operate, but whether to strictly follow the basic principles of standardized lung cancer treatment. Only surgery that adheres to these principles can truly prolong the patient’s survival time. These are also the main background of the standardized individualized treatment of lung cancer since the 1990s, when the Center for Minimally Invasive Thoracic Surgery of Peking University People’s Hospital started to propose it. So, what are the main components of the standardized treatment strategy for lung cancer? Generally speaking, for early stage (stage I and II) lung cancer, as long as the patient’s physical condition can tolerate it, radical surgical resection should be considered first, followed by some adjuvant chemotherapy. In such cases, simple local excision of the lesion obviously cannot solve the fundamental problem and prolong the patient’s survival time is very limited. As mentioned earlier, the standard treatment principle is that such patients should first receive about two courses of preoperative chemotherapy after a clear diagnosis, and then undergo surgery, which is followed by complementary chemotherapy and/or radiotherapy; for locally advanced lung cancer that already has invasion of adjacent organs such as the heart, large blood vessels, chest wall, etc., although radical resection is difficult or impossible, some of the procedures aimed at improving the patient’s symptoms and relieving pain palliative surgery, such as pericardial windowing, pleural fixation, or even simple thoracentesis, are irreplaceably important to improve the patient’s quality of survival; for advanced lung cancer that already has metastases to distant organs throughout the body, surgery is also meaningful in some special cases, such as those with isolated brain metastases from the primary lung cancer (which are more common clinically), and after the metastases are removed For example, in the case of primary lung cancer with isolated brain metastases (which is more common in clinical practice), radical resection of the primary lung lesion after the metastasis is removed is also of great importance to prolong the survival time of the patient. On the contrary, it is an important and irreplaceable tool in lung cancer treatment. The main thread running through this issue is the principle of standardized treatment of lung cancer.