About 1/3 of lung cancers are already locally advanced when detected, i.e. non-small cell lung cancer (NSCLC) in which the tumor invades important local structures such as pericardium, heart, large blood vessels, esophagus and tracheal ramus, and no distant metastasis is detected by available screening methods. Although there is still controversy over whether surgery or chemotherapy should be given first for operable locally advanced NSCLC, recent evidence suggests that surgery should be the first choice for these patients, especially for squamous carcinoma. With technological advances and newer equipment, minimally invasive techniques, represented by thoracoscopic techniques, are also increasingly used for the treatment of locally advanced NSCLC. How to benefit from this surgical option is an issue that all thoracic surgeons must consider when choosing between open and lumpectomy surgery. How can patients with locally advanced disease benefit from surgery? We must clarify the following questions. What is thoracoscopic surgery? Surgical approaches for locally advanced NSCLC include conventional incision, minimally invasive small incision, thoracoscopically assisted small incision and total thoracoscopy. We believe that only one surgical method, full thoracoscopic surgery, is a true thoracoscopic surgery. In principle, the incision is as small as possible, the whole muscle is not cut, the rib cage is not opened with propping instruments, the hand does not enter the chest cavity, and the thoracoscopic instruments are used exclusively. A thoracoscopically assisted procedure with a direct visual incision is not a true thoracoscopic procedure and should be defined as a broad “hybrid” thoracoscopic procedure. Does the surgeon have sufficient experience in thoracoscopic surgery? The “personalization” of surgery depends on the experience and ability of the surgeon, and the risk of lumpectomy for locally advanced NSCLC is high, so the surgeon must first have an awareness of tumor-free and have extensive experience in thoracoscopic operation. The idea of “show” or “satellite” should not be taken, and the surgery should not be done for the sake of completing a difficult lumpectomy. The immediate safety of surgery is the primary goal, while the long-term quality of life and survival is the ultimate goal. Therefore, attention should be paid to the existence of tumor breakage and tumor implantation in the surgical field in patients with locally advanced disease. Where is the biggest benefit point for patients? The less traumatic the surgery is, the longer the survival is, the greater the benefit is. Although lumpectomy incision is less traumatic, it is more likely to have life-threatening complications if the operation takes longer and bleeds more. Therefore, compared with open surgery, what is less traumatic and has the greatest benefit, where is the greatest benefit point, and what criteria are used to evaluate it? All these questions need to be further studied. If there is a lack of objective evaluation criteria, the debate will continue. Thanks to the rapid development of science and technology, the further development of minimally invasive surgical products such as thoracoscopic surgical instruments and da Vinci robots may provide lasting momentum and broader prospects for the further development of lumpectomy technology. Thoracic surgeons must follow the principle of “maximizing patient benefit is the ultimate goal of thoracoscopic technology development” and adopt a “personalized” approach to maximize patient benefit according to the specific situation. ”In locally advanced NSCLC, no matter what kind of treatment we adopt, the fundamental goal should not be forgotten, which is “all for the benefit of the patient”.