Emerging advances in integrating minimally invasive surgery into the therapeutic landscape of locally advanced non-small cell lung cancer

Locally advanced non-small cell lung cancer (NSCLC) accounts for the majority of lung cancer-specific mortality, yet the therapeutic value of surgery remains contentious. However, driven by the success of recent neoadjuvant clinical trials, the treatment landscape for locally advanced NSCLC has evolved dramatically, significantly influencing patient-reported and oncological outcomes. Consequently, the strategic integration of surgery, particularly minimally invasive surgery (MIS) such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS), into the management of highly selected post-neoadjuvant patients is associated with improved long-term survival. Offering advantages such as reduced intraoperative blood loss, fewer perioperative complications, and faster recovery, MIS is increasingly recommended when feasible, notwithstanding the potential risk of conversion to open surgery. Furthermore, in specialized high-volume centers, MIS currently demonstrates outcomes comparable to or superior to open surgery, even in complex procedures such as post-neoadjuvant sleeve lobectomy and carinal reconstruction. In summary, this review highlights the pivotal role of MIS in managing locally advanced NSCLC and emphasizes the synergy between neoadjuvant therapy and MIS in revolutionizing lung cancer treatment and optimizing patient outcomes.