Lung Multidisciplinary Team Decision-Making Challenges in Perioperative NSCLC: Borderline Resectability and Discordant Responses Through the Lens of Real-World Scenarios

Background: Resectable or potentially resectable stage II–III NSCLC encompasses heterogeneous clinical scenarios. The introduction of neoadjuvant and perioperative strategies has expanded treatment options while increasing the complexity of multidisciplinary decision-making and the need to reassess treatment pathways over time. Methods: We conducted a single-centre retrospective descriptive analysis of 101 patients with clinical or pathological stage II–III NSCLC discussed within our thoracic multidisciplinary team (MDT) between 2023 and 2025. Using MDT meeting records supplemented by medical records, we analysed decision-making trajectories and the main reasons for changes in treatment strategy. Results: Three major decision points emerged: selection of preoperative treatment, reassessment of resectability and operability after preoperative treatment, and postoperative assessment of recurrence risk and feasibility of adjuvant treatment. Treatment pathways were modified according to disease response or progression, surgical feasibility, comorbidities, treatment-related toxicity, pathological findings, and postoperative recovery. Particularly challenging scenarios included heterogeneous stage II disease, borderline resectability, and discordant responses after induction therapy. Conclusions: Perioperative management of stage II–III NSCLC requires dynamic, longitudinal multidisciplinary decision-making rather than a single treatment decision at diagnosis. Integrated reassessment of clinical, pathological, and molecular disease characteristics, treatment response, patient fitness, and surgical feasibility may help individualise treatment pathways.