Follow up and surveillance post lung cancer surgery: a narrative review

Background and Objective: Lung cancer poses a significant global burden of disease, and whilst surgical and oncological therapies have revolutionised management, post-treatment recurrence remains a hurdle. Though there is no universal consensus which agrees upon a follow-up regime for these patients, evidence supports use of radiological imaging to monitor disease recurrence and progression. Through this narrative review, our objective is to compare current guidelines on follow-up and review the optimal imaging modality for follow up in lung cancer patients allowing for a more up to date review.Methods: A comparative analysis of current guidelines in following-up patients after lung cancer resection such as American College of Chest Physicians (ACCP), the National Institute for Health and Care Excellence (NICE) and the European Society of Medical Oncology (ESMO) was performed to look at available recommendations. PubMed database was then used for literature search to identify published papers between 1992 and 2022 in English language. An analysis of relevant existing literature was then performed in the form of a narrative review.Key Content and Findings: Although current guidelines mandate a patient-centred approach to care, they largely differ in their frequency and breadth of investigations at follow-up. The review looked at the various radiological modalities used for follow-up, their risks and benefits to the patients. We also reviewed the recurrence rates of the various pathological types of lung cancer and the disease free periods.Conclusions: Lung cancer management must encompass several factors, including quality of life measurement as well as long-term monitoring with multidisciplinary team input. Whilst most studies favour the use of computed tomography (CT) for surveillance, it is clear there are several drawbacks that include exposing a patient to high dose radiation. There is scope for further studies which explore these factors.

Automated summary

This narrative review compared current guidelines on follow-up for lung cancer patients and evaluated the optimal imaging modality. The study found that there are differences in the frequency and breadth of investigations in current guidelines. CT is considered the most commonly used imaging modality for surveillance, but its high dose radiation poses risks to patients. There is scope for further research to explore these factors.