The field of lung cancer screening has advanced significantly with the widespread implementation of low-dose computed tomography (LDCT), which has been shown to reduce mortality in high-risk individuals. As these screening programs are adopted globally, the involvement of thoracic surgeons has expanded from the traditional treatment of early-stage tumors to a broader role in multidisciplinary assessment, especially when incidental findings are detected. Despite the clear survival benefits associated with early detection and intervention, contemporary clinical practice grapples with challenges such as determining surgical indications for various nodule types, defining optimal patient selection strategies, and managing indeterminate or benign lesions. Recent studies have highlighted the transformative impact of minimally invasive and robotic surgical techniques, noting shorter recovery times and lower morbidity, even among patients with frailty or complex anatomies. However, ongoing debates persist regarding the best approaches to resection, the appropriate extent of surgery for screen-detected lesions, and the integration of emerging technologies like artificial intelligence and radiomics in preoperative planning and intraoperative decision-making.

This Research Topic aims to delineate the evolving responsibilities and innovations in thoracic surgery within the context of lung cancer screening. The primary objectives are to explore refined criteria for surgical intervention, evaluate risk stratification and outcomes in patients undergoing resection for screen-detected or incidental lesions, and assess the utility of advanced technologies in enhancing surgical decision-making. In addition, the topic seeks to clarify the multidisciplinary role of surgeons in interpreting and managing incidental findings, to optimize both patient outcomes and healthcare resource allocation. Studies that address patient selection mechanisms, surgical learning curves, comparative surgical approaches, and long-term oncologic outcomes are especially encouraged to bridge prevailing knowledge gaps.

To gather further insights within the domain of surgical management and decision-making in lung cancer screening, this Research Topic welcomes submissions that focus on the defined range of patient selection, intraoperative strategies, and management of incidental findings, while excluding broader oncologic or non-surgical interventions. We welcome articles addressing, but not limited to, the following themes:

-Surgical management of screen-detected early-stage lung cancer
-Patient selection and risk models for surgery in screening programs
-Outcomes and learning curves for minimally invasive or robotic resections
-Management of incidental or extrapulmonary findings identified by LDCT
-Impact of sublobar resections versus lobectomy in early-stage disease
-Role of surgeons in multidisciplinary screening pathways
-Cost-effectiveness and organizational implications of surgical involvement
-AI and radiomics applications in surgical planning for screened patients

By bringing together international experts and diverse perspectives, this Research Topic aims to provide a comprehensive overview of how thoracic surgeons can contribute to—and reshape—the future of lung cancer screening.

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Surgical Perspectives in Lung Cancer Screening: Patient Selection, Incidental Findings, and Management of Early-Stage Disease