Non-small-cell lung cancer (NSCLC) is responsible for more deaths each year in the United States than is any other malignancy. Early stage disease can be cured with surgical resection. Postoperative surveillance for recurrent disease and the development of second malignancies are important parts of the overall treatment plan. Follow-up strategies have been analyzed and guidelines (most notably those of the National Comprehensive Cancer Network ) have been published. However, common practice often does not comply with these rationally developed guidelines. Understanding the general principles of effective surveillance may improve compliance with the guidelines and may lead to more cost-effective management. New methods of surveillance, postoperative risk stratification, and emerging therapies may alter these recommendations for postoperative surveillance of patients with early stage NSCLC in the future.