Surgery is the preferred treatment for resectable esophageal cancer, but in locally advanced esophageal cancer, the effect of surgery alone is not ideal, so surgery-based comprehensive treatment is the best option. Neoadjuvant therapy has become a standard treatment in the treatment of locally advanced resectable esophageal cancer. Neoadjuvant therapy includes neoadjuvant chemotherapy, radiochemotherapy, immunotherapy, targeted therapy, etc. With the significant efficacy and acceptable toxicity of immunotherapy in the first-line and second-line treatment of advanced esophageal cancer, neoadjuvant immunotherapy has become a research hotspot of locally advanced resectable esophageal cancer. This article reviews the latest research progress and some limitations of neoadjuvant immunotherapy in locally advanced resectable esophageal cancer.
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.
