J.Jpn. Surg. Soc.. 127(2): 152-163, 2026

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Feature topic

SURGERY FOR LUNG CANCER IN THE ERA OF IMMUNE CHECKPOINT INHIBITORS

The introduction of immune checkpoint inhibitors (ICIs) has become a “game-changer” in the treatment of unresectable nonsmall cell lung cancer (NSCLC). Several randomized clinical trials have shown that systemic therapy using ICIs provides superior clinical outcomes over platinum-based chemotherapy, which had been the standard treatment for advanced NSCLC. In some patients with unresectable advanced disease at the initial diagnosis, systemic therapy using ICIs may provide robust antitumor effects such as long-term tumor shrinkage. In such cases, salvage surgery may be indicated for selected patients, which can lead to a favorable prognosis. Recently, ICIs have also been evaluated in preoperative neoadjuvant therapy for resectable patients and/or in postoperative adjuvant therapy for resected patients, which have provided significant survival benefits along with superior pathological effects. In this article, we review current systemic therapy using ICIs for resectable patients as well as for unresectable patients and discuss several issues in applications of multidisciplinary therapy including surgery for an individual patient.

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