The number of patients with early lung cancer, which is detected by screening high risk group for lung cancer using sputum cytology, or by screening using CT is increasing. Recent studies have shown that some histologic types of early peripheral adenocarcinoma have no lymph node involvement. In addition, the incidence of multicentricity of peripheral type of early adenocarcinoma, detected by meticulous evaluation of CT images, is not so low. Video-assisted limited resection may be feasible in such cases. In spite of the excellent results of surgical resection for the hilar type of early lung cancer, surgery is at risk in some patients because of underlying pulmonary dysfunction and of a high incidence of second primary lung cancers. Endoscopic photodynamic therapy or brachytherapy may be an alternative to surgery as standard treatment in selected cases.