Surgery With or Without Internal Radiation Therapy in Treating Patients With Stage I Non-Small Cell Lung Cancer

You may be eligible if

• PART I: PRE-OPERATIVE CRITERIA (PRE-REGISTRATION/RANDOMIZATION)
• Patients must have a suspicious lung nodule for clinical stage I non-small cell lung cancer (NSCLC)
• Patient must have a mass =\< 3 cm maximum diameter by computed tomography (CT) size estimate: clinical stage Ia or selected Ib (i.e., with visceral pleural involvement)
• Patient must have a CT scan of the chest with upper abdomen within 60 days prior to date of pre-registration
• Eastern Cooperative Oncology Group (ECOG)/Zubrod performance status 0, 1, or 2
• Patient must meet at least one major criteria or meet a minimum of two minor criteria as described below:
• * Major criteria
• * Forced expiratory volume in 1 second (FEV1) =\< 50% predicted
• * Diffusing capacity of the lungs for carbon monoxide (DLCO) =\< 50% predicted
• * Minor criteria
• * Age \>= 75
• * FEV1 51-60% predicted
• * DLCO 51-60% predicted
• * Pulmonary hypertension (defined as a pulmonary artery systolic pressure greater than 40 mmHg) as estimated by echocardiography or right heart catheterization
• * Poor left ventricular function (defined as an ejection fraction of 40% or less)
• * Resting or exercise partial pressure of oxygen (pO2) =\< 55 mm Hg or peripheral capillary oxygen saturation (SpO2) =\< 88%
• * Partial pressure of carbon dioxide (pCO2) \> 45 mm Hg
• * Modified Medical Research Council (MMRC) Dyspnea Scale \>= 3
• Patient must not have had previous intra-thoracic radiation therapy
• Women of child-bearing potential must have negative serum or urine pregnancy test
• No prior invasive malignancy, unless disease-free for \>= 5 years prior to pre-registration (exceptions: non-melanoma skin cancer, in-situ cancers)
• PART II: INTRA-OPERATIVE CRITERIA (REGISTRATION)
• Patient must have biopsy-proven NSCLC
• Patient must have all suspicious mediastinal lymph nodes (\> 1 cm short-axis dimension on CT scan or positive on positron emission tomography \[PET\] scan) assessed by one of the following methods to confirm negative involvement with NSCLC (mediastinoscopy, endo-esophageal ultrasound guided needle aspiration, CT-guided, video-assisted thoracoscopic or open lymph node biopsy)