Lung cancer was a very rare disease in the 19th century, and before 1910, there were only 200 documented cases of lung cancer worldwide. In the last 100 years since then, due to smoking and industrialization, the incidence of lung cancer has increased parabolically and has rapidly become the leading cause of death from tumors in both men and women. Non-small cell lung cancer accounts for approximately 80% of the total lung cancer cases. Since most patients have distant metastases at the time of initial presentation, only a small percentage of patients are still in the early stage of lung cancer, and it is this small percentage of patients that are most clinically valuable for treatment. In this article, we review the current status of treatment for early stage non-small cell lung cancer and the current problems. In 1944, Denoix first proposed the anatomical scope of tumor by primary tumor (T), regional lymph nodes (N), and whether there are distant metastases (M), etc. The Union International Contre le Cancer (UICC) developed the earliest staging method for lung cancer in 1964 based on Denoix’s suggestion. In 1978, the UICC introduced the first international TNM staging standard for lung cancer, and after continuous revision, the UICC and AJCC jointly introduced the new international lung cancer staging standard in 1986, which unified the lung cancer staging, T1-2N0M0 for stage I and T1-2N1M0 for stage II. stage II. In 1997, the UICC and AJCC adopted the new revised international lung cancer staging standards, which made the lung cancer staging more interesting and reasonable. The biggest change in the revised national staging of lung cancer (1997) is the refinement of staging, further dividing stages I and II into two subgroups A and B, and dividing T3N0M0, which originally belonged to stage IIIA, into IIB. Stage I lung cancer (IA: T1N0M0; IB: T2N0M0) (a) Current situation: surgical resection is the first choice of treatment for stage I lung cancer 1. Surgical incision: the standard posterior-lateral incision is still the current domestic The standard posterior lateral incision is still the commonly used surgical approach in China; while in developed countries, the axillary transverse or longitudinal incision (especially the small incision at the same time) preserving the pectoral muscle is the most common incision for early-stage lung cancer. This incision preserves the integrity of the latissimus dorsi and serratus anterior muscles of the chest without removing and cutting the ribs, and results in rapid postoperative functional and muscular recovery; however, it is still controversial whether it can reduce the postoperative pain of the incision. TV thoracoscopic lung cancer surgery has got certain indications, especially for patients whose lung function cannot tolerate large resection such as open chest or lung lobes, and can also be selectively used for lobectomy and total pneumonectomy. 2.Surgery: For stage I NSCLC patients, as long as the patient’s physical condition and lung function can tolerate surgery, surgical resection is the “gold standard” of treatment. Lung cancer surgery consists of three important parts, namely: (1) intraoperative determination of diagnosis and stage, (2) complete resection of the tumor, and (3) sampling or dissection of each group of lymph nodes in the possible lymphatic drainage area. The current basic procedure is lobectomy and lymph node dissection. It is the ideal procedure when lung cancer is confined to one lobe, and the surrounding tissues (including pleura) and lymphatic drains can be removed together. Ginnsberg (1983) reported a 2% mortality rate for lobectomy, which has been reduced in recent years. Other procedures include double lobectomy or total pneumonectomy. If the patient’s lung function is poor, limited pneumonectomy, such as segmental lung resection and wedge lung resection, can also be performed. 3, postoperative survival: LCSG analyzed 907 cases of PT1N0M0 patients from 1977 to 1988, and the median survival time was about 8 years. The factors affecting tumor survival include the size and location of the primary tumor. Read (1990) reported that the prognosis of T1N0 lesions with a diameter equal to or less than 2 cm was significantly better than that of T1 lesions with a diameter between 2-3 cm. Ishida (1990) reported that the prognosis of T1N0 tumors with a diameter of less than 1 cm was significantly different from that of those with a diameter of 2-3 cm, while it was not significantly different from that of those with a diameter of 1-2 cm. . Padilla (1997) reported that the 5-year and 10-year survival rates for PT1N0 lesions less than 2 cm in diameter were 87% and 74%, respectively, while those with 2-3 cm in diameter had 65% and 49% survival rates. clinical stage T1N0 lesions, the chance of pathologic N2 lymph node metastasis increases with increasing tumor diameter, contributing to their poor prognosis.Mountain’s large group follow-up data showed that the 5-year survival rates for stage IA and IB NACLC were approximately 67% and 57%, respectively, rather than the theoretical 100%. This suggests that about 30-40% of the so-called stage I lung cancers are actually advanced, but are not yet detectable by current technical means. The five-year survival rate of patients with stage I lung cancer who have undergone surgical resection is satisfactory. Other treatment methods such as chemotherapy and radiotherapy are not effective. (II) Controversy 1. Preoperative evaluation: are PET, MRI, bone scan, tracheoscopy and mediastinoscopy routinely applied? 1. PET: There have been many reports in the literature on the use of PET to identify the benignity and malignancy of intrapulmonary lesions and the presence or absence of systemic metastases. Some consider it to be a fairly good qualitative diagnostic method for lung cancer, with a sensitivity of 90-95% and specificity of about 80% when used in combination with CT. However, reports of misdiagnosis rates are increasing, with false positives seen in granulomatous disease, etc., and false negatives mostly seen in carcinoid or adenocarcinoma, etc. In addition, due to the influence of technology, price, equipment popularity and performance, although some people advocate its wide use, it cannot be used as a routine preoperative examination for stage I lung cancer at present. It is believed that with the improvement of technology and the popularization of application, PET will have good application prospects. 2.MRI: From the anatomical information, MRI is less effective than CT in most of the intrathoracic areas; however, with the exception of a few areas, such as the superior pulmonary sulcus, the near thoracic vertebrae and the near mediastinal area, the display effect is better. In recent years, in order to improve the role of MRI in mediastinal lymph node staging, a smaller molecular weight biodegradable iron oxide molecule encapsulated with low molecular dextrose, Combidex, has been used as a tracer for MRI enhancement scans, but its diagnostic value needs to be further summarized. Currently MRI can only be used selectively for preoperative evaluation of stage I lung cancer.