Does a benign osteosarcoma require surgery? First, it needs to be clarified that there is no such thing as a benign osteosarcoma; osteosarcomas are definitely malignant and their degree of malignancy is relatively high. According to the Enneking staging, they are classified as Stage IIB and are highly prone to distant metastases, such as lung and brain metastases. Therefore, if osteosarcoma is described as benign, the first point is that it is a diagnostic error—it is not osteosarcoma; the second point is a misunderstanding, as osteosarcoma only has malignant forms. Additionally, how should osteosarcoma be treated? Currently, there is a treatment called neoadjuvant chemotherapy, which involves 6-8 sessions of chemotherapy before surgery. After the symptoms subside and the tumor size reduces, the specific circumstances of the patient determine whether conservative or timely treatment is chosen, followed by continued chemotherapy after surgery. This approach helps significantly improve the five-year and ten-year survival rates of osteosarcoma patients. Therefore, it is important to note two points: first, osteosarcoma is not benign but malignant; second, the current treatment for osteosarcoma mainly revolves around surgical combined treatment methods.