Beyond resection: imaging findings of expected and complicated postoperative changes in lung cancer

Lung cancer remains the leading cause of cancer-related mortality, with surgical resection as the primary curative treatment for early-stage non-small cell lung cancer. However, distinguishing normal postoperative changes from complications on chest radiographs and CT scans presents a significant diagnostic challenge, necessitating precise radiologic interpretation. Postoperative complications manifest across a broad spectrum of timing and severity. Early complications include persistent air leak, pneumonia, and bronchopleural fistula, while late complications include bronchial anastomotic stricture, lung herniation, and unilateral pleuroparenchymal fibroelastosis. In addition, rare but clinically significant complications, such as lobar torsion, acute exacerbation of interstitial pneumonia, and pulmonary vein stump thrombosis, warrant careful consideration due to their potential for severe morbidity. Accurate identification of expected postoperative imaging findings and complications is essential to ensuring timely diagnosis and preventing unnecessary interventions. This review synthesizes current knowledge on surgical procedures, expected postoperative imaging findings, and key complications to refine radiologists' diagnostic acumen and ultimately improve patient outcomes.