A proposal of postoperative follow-up pathways for lung cancer

Although follow-up surveillance after resection for lung cancer is commonly performed in clinical practice, there is no standard follow-up program. We attempted to establish follow-up examination schedules that we considered would be acceptable to the majority of doctors, and would like to propose them as standard postoperative follow-up pathways.

We carried out a retrospective analysis of patients' data and reviewed the time of detection of recurrence and the site of recurrence after resection. Published papers were also reviewed. The postoperative follow-up pathways were established based on these data.

The follow-up period was set at as 5 years after resection, and physical examinations, chest radiography, chest CT and blood examination are recommended. Two follow-up pathways were proposed taking the risk of recurrence into consideration: the Risk of recurrence-based pathway and the Comprehensive pathway. In the Risk of recurrence-based pathway, the follow-up examination schedule is modified according to the risk of recurrence. In the Comprehensive pathway, a single universal examination schedule is recommended for all patients. The choice between these two pathways is left to the discretion of the attending doctor.

We proposed two follow-up pathways, based on retrospective analysis of patients' data and a review of published papers, which we considered would be acceptable to the majority of doctors and would be suited to the current medical environment in Japan. A prospective study to evaluate the efficacy of the follow-up pathways is ongoing.