Feasibility and Early Outcomes of Surgery After Neoadjuvant Chemoimmunotherapy in Locally Advanced Non–Small Cell Lung Cancer

Abstract Introduction: Treatment approaches for locally advanced non–small cell lung cancer (NSCLC) require multidisciplinary evaluation. In recent years, the addition of immunotherapy to neoadjuvant chemotherapy has been reported to increase pathological response rates. This study aimed to compare surgical feasibility and early outcomes in patients with locally advanced NSCLC who received neoadjuvant chemotherapy or neoadjuvant chemoimmunotherapy and subsequently underwent anatomical lung resection. Methods Patients who underwent surgery for locally advanced (Stage IIB–IIIB, 9th TNM) NSCLC in our clinic between January 2024 and September 2025 were retrospectively evaluated. Patients who received neoadjuvant chemotherapy were classified as Group A, while those who received neoadjuvant chemoimmunotherapy were classified as Group B. Clinical, surgical, and pathological data were compared using univariate and multivariate analyses. Results A total of 76 patients were included in the study; 47 (61.8%) received neoadjuvant chemotherapy and 29 (38.2%) received neoadjuvant chemoimmunotherapy. Demographic characteristics were similar between the groups. Operation time was significantly longer in Group A (p = 0.005). Minimally invasive surgery (VATS) was performed at a significantly higher rate in Group B (p = 0.02). The postoperative pathological T stage was earlier in Group B (p = 0.019), and the pathological complete response rate was significantly higher in the chemoimmunotherapy group (p = 0.001). Although postoperative complication rates were similar between the groups, 30- and 90-day mortality rates were higher in Group B in univariate analysis. No significant difference was observed between the groups in terms of median survival (p = 0.353). Conclusion Neoadjuvant chemoimmunotherapy followed by surgery is a technically safe and feasible approach for patients with locally advanced non–small cell lung cancer. The addition of immunotherapy to neoadjuvant chemotherapy provides a significant pathological advantage, as evidenced by higher pathological complete response rates and earlier pathological T-stage compared with chemotherapy alone. These findings support the role of neoadjuvant chemoimmunotherapy in improving tumor regression and pathological downstaging without compromising surgical feasibility. However, careful patient selection and close postoperative follow-up are warranted due to the observed early mortality. Larger prospective, randomized studies with longer follow-up are required to clarify the impact of neoadjuvant chemoimmunotherapy on long-term survival outcomes.