- 1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
- 2. Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
CHE Guowei,
Email: chebenben2005@163.com
In recent years, the introduction of immune checkpoint inhibitors has significantly reshaped the therapeutic landscape for non-small cell lung cancer (NSCLC). Neoadjuvant immunotherapy (as monotherapy or in combination with chemotherapy) can significantly improve pathological response rates and has also demonstrated survival benefits when utilized within a comprehensive treatment regimen in combination with surgery. However, the tumor microenvironment remodeling induced by immunotherapy and immune-related adverse events present new challenges for surgical treatment strategies. This article addresses key issues in the surgical management of NSCLC in the context of neoadjuvant immunotherapy, focusing on three phases: preoperative, intraoperative, and postoperative, to explore the impact of immunotherapy on the selection of the time to surgery (TTS) and the optimal TTS, whether immunotherapy increases the difficulty and complexity of surgery, and whether immunotherapy affects the risk of perioperative complications. The aim is to provide guidance for surgical decision-making in clinical practice and to establish a foundation for future research directions.
Copyright ? the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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- 9. Forde PM, Spicer JD, Provencio M, et al. Overall survival with neoadjuvant nivolumab plus chemotherapy in lung cancer. N Engl J Med, 2025, 393(8): 741-752.
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- 16. Liu J, O’Donnell JS, Yan J, et al. Timing of neoadjuvant immunotherapy in relation to surgery is crucial for outcome. Oncoimmunology, 2019, 8(5): e1581530.
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- 22. Wang J, Song P, Ge Y, et al. Effect of interval between neoadjuvant immunochemotherapy and radical resection of non‐small cell lung cancer: a multicenter, retrospective cohort study. Int J Cancer, 2026. Epub ahead of print.
- 23. Gu C, Teng X, Sun X, et al. Impact of treatment interval between neoadjuvant immunochemotherapy and surgery in lung squamous cell carcinoma. BMC Cancer, 2024, 24(1): 585.
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- 25. Li M, Yin H, Jin Y, et al. A real-world study of resectable NSCLC following neoadjuvant immunotherapy: should postoperative adjuvant immunotherapy be recommended? Thorac Cancer, 2025, 16(23): e70195.
- 26. Marinelli D, Nuccio A, Di Federico A, et al. Improved event-free survival after complete or major pathologic response in patients with resectable NSCLC treated with neoadjuvant chemoimmunotherapy regardless of adjuvant treatment: a systematic review and individual patient data meta-analysis. J Thorac Oncol, 2025, 20(3): 285-295.
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- 28. Zhang J, Feng Y, Dai S, et al. Neoadjuvant chemoimmunotherapy in non-small-cell lung cancer patients: effects on pulmonary function and incidence of postoperative pulmonary complications:a multicentre real-world study. Eur J Cardiothorac Surg, 2025, 67(11): ezaf351.
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- 30. Watanabe T, Nomura K, Takamori S, et al. Preoperative immune-related adverse events in resectable NSCLC treated with neoadjuvant nivolumab plus chemotherapy: a multicenter retrospective analysis. JTO Clin Res Rep, 2026, 7(1): 100930.
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- 33. Mitsudomi T, Heymach JV, Reck M, et al. Surgical outcomes with neoadjuvant durvalumab plus chemotherapy followed by adjuvant durvalumab in resectable NSCLC. J Thorac Oncol, 2025, 20(11): 1639-1654.
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- 35. Zhao J, Zhao L, Guo W, et al. Efficacy, safety, and biomarker analysis of neoadjuvant camrelizumab and apatinib in patients with resectable NSCLC: a phase 2 clinical trial. J Thorac Oncol, 2023, 18(6): 780-791.
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- 38. Wu H, Jiang L, Li J, et al. Influence of neoadjuvant immunotherapy on surgical approaches in non-small cell lung cancer: insights from a Chinese expert questionnaire survey on contemporary practices. J Thorac Dis, 2025, 17(11): 9364-9374.
- 39. Trabalza Marinucci B, Mancini M, Siciliani A, et al. Surgical techniques for non-small-cell lung cancer after neoadjuvant chemo-immunotherapy: state of art and review of the literature. Cancers, 2025, 17(4): 638.
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