Neuroendocrine tumors account for approximately 20% of lung cancers, and of these, small cell lung cancer (SCLC) accounts for approximately 75% of neuroendocrine tumors. Small cell lung cancer has a short multiplication time and a short cell division cycle that leads to early hematogenous metastasis, and thus only about one-third of patients are found to be in the limited stage. Chemoradiotherapy is the standard of care for limited-stage small cell lung cancer, while surgery is used in only a small percentage of patients with stage I small cell lung cancer – 2-5%. Small cell lung cancer tends to be sensitive to initial radiotherapy, but despite this, most patients often die from recurrent disease due to the development of drug resistance. Currently, the NCCN guidelines recommending surgical resection for small cell lung cancer are still limited to stage I (T1-2N0M0) patients, based on evidence from two randomized controlled studies published in the Lancet and Chest journals in 1973 and 1994, respectively, which concluded that surgery + radiotherapy versus chemoradiotherapy alone for limited stage small cell Lung cancer, the median survival was 15.4 months and 18.6 months, respectively, with no statistically significant difference between the two groups. Following these two studies, there was a substantial decrease in surgical resection of small cell lung cancer cases and chemoradiotherapy dominated the treatment of small cell lung cancer, however, nowadays, more and more scholars are questioning the indications for small cell surgical treatment, partly because scholars believe that its evidence-based medical evidence is too old, as imaging techniques such as CT and PET and mediastinoscopy and EBUS- TBNA and other biopsy techniques have been limited in their application, resulting in less accurate disease staging and an underestimation of the status of surgery. In addition, the current standard first-line chemotherapy regimen for the treatment of small cell lung cancer is etoposide combined with platinum-based drugs, whose efficiency can be as high as 90% or more, and that study in 1973 whose drug therapy remained in the CAV regimen, whose efficiency was about 50%, and the low effectiveness of induction chemotherapy also reduced the effectiveness of surgical treatment to some extent. In recent years, although most scholars still believe that combined radiotherapy is the standard treatment for small cell lung cancer, more and more surgical teams believe that surgery can completely cure stage I and stage II SCLC. several national and international retrospective studies have shown that surgery can achieve clinical cure and long-term survival in 50-80% of stage I and approximately 35-50% of stage II SCLC. These improved survival data clearly issue new challenges to the indications for surgical resection of SCLC. In this regard, the surgical team of the Department of Thoracic Surgery II at Peking University Cancer Hospital, where I work, also reviewed and analyzed the status of surgical resection in the treatment of limited-stage small cell lung cancer. From 2004 to 2011, a total of 59 patients with small cell lung cancer were treated surgically by the surgical team of the Second Department of Thoracic Surgery at Peking University Cancer Hospital. Progression-free survival (PFS) and overall survival (OS) were statistically analyzed to compare the survival differences between radical and non-radical resection, direct surgery and preoperative chemotherapy groups, and between different stages. 54 of the 59 patients were planned for radical resection in stages I-III, and the overall 5-year survival rate was 49%, of which 42.6% (23/54) had preoperative chemotherapy. patients underwent preoperative chemotherapy. The radical resection rate in the preoperative chemotherapy group was 82.6% (19/23) compared to 54.8% (17/31) in the direct surgery group, with a statistical difference between the two groups (p=0.032) (Appendix Figure 1). The 5-year survival rate was 59% in the preoperative chemotherapy group and only 22% in the direct surgery group, which was statistically different (p=0.041) (Figure 2 attached). Among the 36 patients with radical resection (lobectomy + lymph node dissection), the 5-year survival rates were 59%, 53% and 26% for stage I, II and III patients, respectively (Supplementary Figure 3). For the 30 stage III patients, the 5-year survival rates were 26% and 67% in the radical resection and non-radical resection groups, respectively, i.e., the survival of stage III patients with radical resection was inferior to that of non-radical resection. analysis of PFS showed the same trend. Our study concluded that for limited-stage small cell lung cancer to be treated surgically, it should first receive preoperative chemotherapy. Complete surgical resection can benefit patients with stage I and II small cell lung cancer. Surgery does not provide a survival benefit for patients with stage III small cell lung cancer with recalcitrant mediastinal lymph node metastases after chemotherapy. Peripheral SCLC with only one isolated lesion in the lung is usually diagnosed at surgery. Peripheral isolated SCLC accounts for 4-12% of all SCLC patients, and these patients are usually found to have an isolated nodal lesion in the periphery on chest CT and are morphologically indistinguishable from non-small cell lung cancer, which is not diagnosed by bronchoscopy and can only be confirmed after surgical resection. Only these patients are allowed to receive direct surgical treatment because their survival is significantly better than that of patients treated with surgery alone, either with preoperative chemotherapy or postoperative chemotherapy, and some studies have shown that the 5-year survival of stage I SCLC surgical resection combined with chemotherapy is as high as 70-80%. Second, radiotherapy also plays an important role in the treatment of small cell lung cancer, including chest radiotherapy and prophylactic brain irradiation. In the author’s opinion, radiotherapy combined with surgery for certain indications may be the best treatment mode for the treatment of limited-stage small cell lung cancer. What is the future direction of surgical treatment for SCLC? This is a question that oncologists in the new century need to answer urgently. In particular, it is urgent to carry out new multicenter randomized controlled clinical trials to reconceptualize the role and place of surgery in the treatment of limited stage I and stage II small cell lung cancer. There is also a need to conduct RCT studies of preoperative neoadjuvant radiotherapy in combination with surgery for some limited stage III SCLC. Finally, in this era of individualized treatment for non-small cell lung cancer, the question of where the individualized treatment of SCLC lies remains to be answered by more clinical studies.