ESTS Post-Conference Essay on Surgery and SABR: Teammates or Rivals? The 23rd Annual Meeting of the European Society of Thoracic Surgeons (ESTS) was successfully held in Lisbon, Portugal, from May 31 to June 3 this year, with thousands of thoracic surgeons from all over the world attending the event. This year’s meeting maintained the traditionally rich and diverse features of ESSS annual meeting, covering almost all current hot topics in thoracic surgery. I have the honor to attend this European thoracic surgery event, and I would like to introduce a topic of my own interest: the discussion of two treatment modalities (surgery and stereotactic ablative radiotherapy) for early-stage lung cancer at this year’s meeting. Stereotactic ablative radiotherapy (SABR) is an important treatment for early-stage lung cancer, which is mostly used for inoperable early-stage lung cancer in the past, but for resectable early-stage lung cancer, the value and status of SABR compared with surgery is a hot topic of discussion in the academic community. On the eve of this annual meeting, Lancet Oncol coincidentally published a pooled analysis of two randomized trials of stereotactic radiotherapy versus lobectomy for resectable early-stage lung cancer, combining the survival data of a total of 58 patients from the STARS and ROSEL studies. It should be said that this result made the author, a surgeon, feel a little pressure, and SABR, a former teammate of lung cancer surgery, is now more like a tit-for-tat opponent. Therefore, I was very eager to hear the views of the academic leaders at this year’s meeting, and the trip to Lisbon did not disappoint me. In the Brompton Session, the most important of the conference presentations, Janet Edwards of the University of Calgary, Canada, the winner of this year’s best presentation, first threw a wet blanket on surgery, using a microsimulation model to predict the impact of SABR on the volume of thoracic surgery for early-stage lung cancer in Canada. With the impact of lung cancer screening, the projected volume of surgical procedures for resectable lung cancer will peak in 2027 with a 49.4% increase, however, with increased treatment adherence to SABR, surgical volumes will decrease dramatically by up to 49.1% (assuming 90% of stage IA NSCLC is treated with SABR.) Edwards seems to be reminding the surgical community that SABR is coming on strong The following day’s Techno meeting at …… brought the discussion of this topic to a climax. The topic “Management of early-stage lung cancer: does minimally invasive surgical treatment versus stereotactic radiotherapy meet the evidence-based consensus?” was the only one of the six topics in the session to have two professors present. Prof. Scott Swanson from Harvard Medical School, USA as “pro Surgery” and Prof. Michael Snee from Leeds Cancer Centre, UK as “pro SBRT” presented on the clinical aspects of VATS and SABR for early stage lung cancer respectively. Professor Scott Swanson as “pro Surgery” and Professor Michael Snee as “pro SBRT” from Leeds Cancer Centre, UK summarized and reported on the clinical evidence of VATS and SABR for early stage lung cancer. Professor Swanson defended the role of surgery in the treatment of early stage lung cancer with the topic “The best treatment for small lung cancer: VATS surgical resection”, pointing out that minimally invasive surgery improves the safety of surgery for high-risk patients, ensuring safe margin distance and lymph node staging. Professor Michael Snee, on the other hand, analyzed the advantages of SABR treatment over surgical treatment with the title “Evidence for SABR treatment of early-stage lung cancer”, and pointed out that SABR is more effective in treating early-stage lung cancer, and the local recurrence rate is not higher than that of surgery, and it is safer and more economical than surgery, giving older and high-risk patients a chance to be treated. The two randomized studies included in the aforementioned Lancet Oncol pooled analysis were not completed and the sample size was too small to provide clinical evidence of adequate efficacy. The presentations on surgery and SABR by the speakers at the ESTS meeting were excellent. However, as stated in “pro Surgery” and “pro SBRT”, the value and status of SABR in early stage lung cancer needs to be supported by high quality clinical evidence. In summary, surgery and SABR have their own advantages and disadvantages, surgery is superior in radical treatment, SABR is strong in safety, the development of minimally invasive surgery and the advancement of SABR technology make the indications for both of them intersect more and more, but for the fight against lung cancer, both of them are certainly teammates. In the author’s opinion, with the available evidence, surgery is the mainstay, SABR is the supplement, and individualized selection is still the most ideal treatment mode for early-stage lung cancer.