Perioperative Systemic Therapies in Resectable Non-Small Cell Lung Cancer: Opportunities and Challenges

Background/Objectives: Recent advancements in immunotherapy have significantly reduced recurrence rates and improved distant outcomes of patients with non-small cell lung cancer. This review synthesizes literature from 2020 to 2025, concentrating on preoperative immunotherapy outcomes. Methods: We analyzed treatment regimens, focusing on primary endpoints, the percentage of patients who underwent initial surgery, type of surgery, R0 rate, immune-related adverse events and chemotherapy-related toxicities as well as the rate of surgery delays and cancelations. Results: Our findings emphasize the importance of optimizing patient selection, effectively managing adverse events, and implementing strategies to minimize surgical delays and cancelations. Conclusions: We defined areas for improvement, such as increasing the implementation of minimally invasive surgeries and avoiding pneumonectomies. These priorities are essential for increasing the efficacy of immunotherapy in surgical settings for NSCLC, and improving patient outcomes.