Studies of surgical approach selection for operable small cell lung cancer (SCLC) are lacking. We retrospectively enrolled 169 patients with pathologically confirmed T1 stage SCLC who underwent video-assisted thoracic surgery (VATS) or open lobectomy. Open surgery does not significantly increase the perioperative risk, but lymph node dissection can be done more thoroughly. The recommendation of VATS as a routine approach for SCLC surgery may still require further study, and until then, open surgery should still be considered. Background: Video-assisted thoracic surgery (VATS) has been widely used in the surgical treatment of thoracic diseases, and it suggested surgical and oncological advantages compared with open surgery. However, reports on the application of VATS in surgery of small cell lung cancer (SCLC) are scarce. This study aimed to explore the advantages and disadvantages of different surgical approaches in the treatment of pathological stage T1(pT1) SCLC in terms of safety, clinical outcomes, and lymph node dissection. Patients and Methods: Patients who underwent lobectomy for pT1 SCLC between January 2014 and September 2017 were identified from the National Collaborative Lung Cancer Database (LinkDoc Database). The patients were stratified based on the surgery approach (VATS or open lobectomy). Perioperative outcomes and long-term survival were analyzed using SPSS software. Results: A total of 169 patients with pT1 SCLC met the criteria and were enrolled for this study, including 110 cases of VATS lobectomies and 59 cases of open lobectomies. VATS lobectomy was associated with less blood loss than open surgery (168.1 +/- 237.4 vs. 340.0 +/- 509.8 mL, P = .002). Open lobectomy harvested more N2 LNs (11.8 +/- 8.2 vs. 8.4 +/- 5.8, P = .048) and identified more metastasis positive LNs (3.1 +/- 6.0 vs. 1.4 +/- 3.0, P = .050). Open lobectomy associated with longer overall survival (OS) but has no statistical difference (23.4 +/- 13.2 vs. 20.2 +/- 10.9, P = .070). Conclusion: Open lobectomy had better lymph node dissection results, and comparable postoperative complications, postoperative hospital stay, and OS to VATS lobectomy. Further studies may still be needed to confirm the recommendation of thoracoscopic approach as a routine surgical procedure for operable SCLC, and until then, open surgery should still be considered. (C) 2021 Elsevier Inc. All rights reserved.