Purpose <p>To compare survival outcomes of surgical resection versus concurrent chemoradiotherapy in patients with stage T1-2N0M0 small cell lung cancer (SCLC).</p> Materials and methods <p>We extracted stage T1-2N0M0 SCLC from the Surveillance, Epidemiology, and End Results database between 2000 and 2020. Kaplan-Meier analysis and Cox proportional hazards regression were employed to assess cancer-specific survival (CSS) and overall survival (OS).</p> Results <p>The study cohort comprised 190 patients undergoing surgical resection and 371 patients receiving chemoradiotherapy. Median CSS was significantly longer in the surgical group compared to the chemoradiotherapy group (123 months vs. 33 months). Multivariable analysis confirmed surgery as an independent protective factor for CSS, both before (hazard ratio [HR] = 0.51, 95% confidence interval [CI]: 0.38–0.68; <i>P</i> &lt; 0.001) and after (HR = 0.52, 95% CI: 0.37–0.73; <i>P</i> &lt; 0.001) propensity score matching. Similarly, surgery was associated with significantly improved OS in multivariable analysis before (HR = 0.58, 95% CI: 0.46–0.73; <i>P</i> &lt; 0.001) and after (HR = 0.60, 95% CI: 0.45–0.80; <i>P</i> &lt; 0.001) propensity score matching. Cumulative incidence analysis revealed a significantly higher 5-year SCLC-specific mortality rate in the chemoradiotherapy group (57.1% vs. 33.8%, <i>P</i> &lt; 0.001). Conversely, 5-year non-cancer mortality (13.3% vs. 16.4%, <i>P</i> = 0.984), lung comorbidity-related mortality (3.5% vs. 3.2%, <i>P</i> = 0.228), and cardiovascular mortality (3.5% vs. 2.6%, <i>P</i> = 0.713) were comparable between the two groups.</p> Conclusion <p>Surgical resection is associated with significantly superior survival outcomes compared to chemoradiotherapy in patients with stage T1-2N0M0 SCLC.</p>