Does Induction Immunotherapy Confer Increased Operative Risk for Lung Resection

The role of surgery in the setting of neoadjuvant and perioperative immune checkpoint inhibitors (ICIs) in the treatment of resectable non-small cell lung cancer (NSCLC) is evolving. Historically, surgery has been the cornerstone for early-stage NSCLC, with adjuvant therapy indicated for high-risk patients. However, the modest survival benefits of traditional chemotherapy have driven the search for more effective treatments. Recent trials of neoadjuvant ICIs have demonstrated significant improvements in major pathologic response and pathologic complete response rates, albeit with increased surgical complexity and a higher rate of open operations. Key considerations include managing attrition rates, handling complex resections post-ICI, and addressing real-world challenges in patient selection. Our recommendations emphasize the combination of neoadjuvant ICI and platinum-doublet chemotherapy for advanced disease, careful evaluation for early-stage patients, and comprehensive preoperative planning.