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Surgical Challenges After Neoadjuvant Therapy.

Olga Ostrovetsky1, Neel P Chudgar1

  • 1Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

Thoracic Surgery Clinics
|November 19, 2025
PubMed
Summary

Neoadjuvant chemoimmunotherapy and EGFR-TKI treatments improve outcomes for early-stage non-small cell lung cancer. Surgeons must understand therapy-induced tissue changes for optimal surgical management in this evolving treatment landscape.

Keywords:
ChemoimmunotherapyLung cancerNeoadjuvant therapySurgical complexityTyrosine kinase inhibitor

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Area of Science:

  • Oncology
  • Thoracic Surgery
  • Medical Research

Background:

  • Neoadjuvant chemoimmunotherapy and epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) show promise for early-stage, resectable non-small cell lung cancer.
  • These therapies are associated with improved pathologic response rates, indicating significant tumor reduction.

Purpose of the Study:

  • To highlight the implications of neoadjuvant therapies on surgical management for non-small cell lung cancer.
  • To prepare surgeons for potential challenges arising from therapy-induced tissue alterations in the real-world setting.

Main Methods:

  • Review of current clinical trial data and therapeutic strategies.
  • Analysis of the impact of neoadjuvant chemoimmunotherapy and EGFR-TKIs on lung tissue.

Main Results:

  • Neoadjuvant chemoimmunotherapy and EGFR-TKIs lead to enhanced pathologic response rates in early-stage NSCLC.
  • Therapeutic interventions cause significant tissue changes that can affect surgical approaches.

Conclusions:

  • The increasing use of these neoadjuvant treatments necessitates a surgeon's awareness of potential intraoperative challenges.
  • Bridging clinical trial findings with practical surgical considerations is crucial for effective patient care in non-small cell lung cancer.