This study represents a retrospective comparison of video-assisted thoracic surgery (VATS) lobectomy with standard open lobectomy for non-small cell lung cancer (NSCLC). The endpoints of this study include surgical stress as measured by interleukin 6 concentration and patient survival. A retrospective review was performed of 240 consecutive patients with clinical stage IA or IB NSCLC who underwent either VATS lobectomy (n=67) or conventional open lobectomy (n=173). The amount of blood loss was significantly less in the VATS group (110+/-75 ml) as compared to 165+/-90 ml for the open lobectomy group (P<0.05). A significantly lower incidence of post-thoracotomy pain occurred in the VATS group (6.2+/-4.1 times/3 days) than in the open lobectomy group (13.5+/-5.8 times/3 days, P<0.0001). The postoperative interleukin (IL)-6 serum concentration of was significantly lower in the VATS group (112+/-43 pg/ml) than that in the open lobectomy group (351+/-133 pg/ml, P<0.001). There was no statistically significant difference in survival between the VATS and open lobectomy groups. The median follow-up was 42 months in both groups. VATS lobectomy for NSCLC is a reasonable treatment option for selected patients with stage I NSCLC.