ABSTRACT
The standard treatment of early-stage non-small-cell lung cancer (NSCLC) is surgery, usually lobectomy or pneumonectomy. Whether surgery should also be the standard of care for very small lesions detected by current screening programs is more controversial. The majority of these screened patients have extensive smoking histories and resultant cardiovascular and pulmonary disease, making surgery a relative or absolute contraindication in many cases. Furthermore, many patients have poor pulmonary function, sometimes due to prior surgery or radiation therapy for a prior, more advanced lung cancer. Synchronous or metachronous primary NSCLC are common in these patients so that lung-sparing strategies for very early lesions might be desirable.
