Small cell lung cancer (SCLC) is characterised by an aggressive and rapid growth, with a tendency towards early metastatic spread. It has one of the worst prognoses of all malignancies. Though radio-chemotherapy is still considered the mainstay of therapy due to its high sensitivity, increasing evidence, supported by a number of retrospective analyses and large case series, suggests that surgery may play a significant role in the treatment of SCLC within a multimodality treatment concept. In this context, surgery can provide overall survival benefit and improve local control in selected cases. Currently, an operation can be recommended if the SCLC manifests as a single peripheral node, in early cancer stages (T1 - 2, N0, M0), in cases of mixed histological tumour types but also in selected cases in chemotherapy-resistant tumors. In the light of the current availability of immunotherapy by checkpoint inhibitors, resection of SCLC should also be considered on the basis of the expression of checkpoint receptors that might have relevant impact on therapy and prognosis of the course of SCLC. In order to fulfil the above-mentioned criteria and to provide a higher level of evidence and to develop guidelines, randomised controlled trials need to be performed.