VATS, or video-assisted thoracic surgery, was widely employed in the surgical treatment of thoracic disorders, and it had shown to have surgical and oncological benefits over open surgery. However, there was little research on the use of VATS in small cell lung cancer (SCLC) surgery. For a study, the researchers sought to determine the benefits and drawbacks of various surgical techniques for treating pathological stage T1(pT1) SCLC in terms of safety, clinical results, and lymph node dissection. Researchers used the National Collaborative Lung Cancer Database to identify patients who had lobectomy for pT1 SCLC between January 2014 and September 2017 (LinkDoc Database). The patients were divided into groups based on how the surgery was performed (VATS or open lobectomy). Researchers used SPSS software to examine perioperative outcomes and long-term survival. A total of 169 patients with pT1 SCLC satisfied the criteria of research, with 110 VATS lobectomies and 59 open lobectomies. Open surgery (168.1±237.4 vs 340.0±509.8 mL, P=.002) resulted in less blood loss than VATS lobectomy. Open lobectomy found more metastasis positive LNs (3.1±6.0 vs 1.4±3.0, P=.050) and collected more N2 LNs (11.8±8.2 vs 8.4±5.8, P=.048). Overall survival (OS) was longer after open lobectomy, although there was no statistical difference (23.4±13.2 vs 20.2±10.9, P=.070). In comparison with a VATS lobectomy, open lobectomy showed better lymph node dissection results, as well as equivalent postoperative complications, postoperative hospital stay, and OS. More research might have been needed to prove the thoracoscopic method as a regular surgical procedure for operable SCLC, and researchers should have still explored open surgery in the meanwhile.