Follow up and surveillance of the patient with lung cancer: What do you do after surgery?

  Of the new cases of lung cancer discovered each year, it has been estimated that 50–55% have localized disease and are thus candidates for potentially curative treatment. Some of these patients will refuse surgery or will have co‐morbidities that preclude surgery. The remainder will undergo an attempted curative resection. A common clinical question arises in these patients: how should this patient be followed after surgery? Post‐treatment surveillance is indicated to monitor for recurrence of the original tumor and for the development of a metachronous tumor. The appropriate protocol is controversial and current recommendations are primarily expert opinion or consensus‐based and await further study. A suggested clinically reasonable and cost‐effective surveillance approach would include a history, physical examination and an imaging study (either chest radiograph or CT) every 6 months for 2 years and then annually. Patients should be counselled on symptom recognition and advised to contact their physician should such symptoms appear.