Neoadjuvant tyrosine kinase inhibitor (TKI) therapy has appeal given the potential for early systemic disease control and tumor downstaging prior to surgery. Until recently, data has have come from smaller series with outcomes from larger trials, including NeoADAURA, ALNEO, and NAUTIKA1, reporting early results. Neoadjuvant use of TKI has been shown to be safe, not delay surgery, and is associated with tumor downstaging. However, pathologic response rates are lower than rates after neoadjuvant immunotherapy, and currently, no data demonstrate that neoadjuvant TKI use improves survival. Use of neoadjuvant TKI remains limited to limited to clinical trials, but this may change soon.

Therapeutic advances with the advent of molecularly targeted therapies and immunotherapy have been revolutionary in the management of advanced NSCLC and recently translated into major progress in earlier stages of NSCLC, reshaping the paradigm of neoadjuvant and adjuvant treatment. Novel therapies with bispecific antibodies and antibody-drug conjugates are now being introduced into the field with the aim to overcome acquired resistance mechanisms and improve patient outcomes. This article reviews new therapeutic models emerging in advanced NSCLC and highlights the role of biomarker testing in optimization of upfront treatment selection to inform potential future opportunities for patients with resectable NSCLC.

This comprehensive article explores the adjuvant use of immunotherapy in resectable lung cancer, specifically highlighting the impact of foundational trials including IMpower010 and KEYNOTE-091. These studies were the first to demonstrate improved survival with perioperative immunotherapy, particularly in programmed death-ligand 1-positive patients. The article also examines the potential of adjuvant immunotherapeutics across non-small cell lung cancer subtypes and in small cell lung cancer. Emerging therapies are discussed, emphasizing the importance of biomarker-driven approaches. Future opportunities for therapeutic development may focus on optimization of patient-specific perioperative strategies through molecular subtyping and combined therapies.

Neoadjuvant chemoimmunotherapy and epidermal growth factor receptor-tyrosine kinase inhibitor are associated with excellent outcomes for patients with early-stage and resectable non-small cell lung cancer. Although they demonstrate increased pathologic response rates, there are also implications for surgical management owing to tissues changes resulting from therapy. With the anticipated increase in uptake of these treatment strategies, it is critical for surgeons to identify potential challenges, especially as clinical trial data transition to the real-world setting.

The evolving landscape of perioperative systemic therapy is transforming the management of resectable non-small cell lung cancer, addressing the limitations of adjuvant chemotherapy alone, the integration of novel therapies in the adjuvant and neoadjuvant settings, and biomarker-guided approaches. It discusses survival benefits associated with targeted therapies and immune checkpoint inhibitors, emphasizing the need for individualized and multidisciplinary strategies, as well as the optimal sequencing of these perioperative regimens.

Lung cancer remains a leading cause of cancer mortality, with high recurrence rates despite surgery. Perioperative therapies, including chemotherapy, immunotherapy, and targeted molecular agents, aim to improve survival rates by reducing residual disease and preventing recurrence. Advances in molecular profiling have led to personalized treatments targeting driver mutations, with recent trials demonstrating significant benefits of adjuvant tyrosine kinase inhibitors. Challenges include timely molecular testing, access to targeted therapies, and managing toxicities. Future directions focus on integrating novel diagnostics such as circulating tumor DNA, optimizing combination strategies, and expanding global access to improve long-term outcomes in resectable non-small cell lung cancer.

For several decades, the standard non-surgical treatment approach for patients with locally advanced non-small cell lung cancer was definitive thoracic radiotherapy with concurrent cytotoxic chemotherapy. Based on recent positive randomized trials, most patients should now be treated with adjuvant immunotherapy or targeted therapy. Future studies should establish novel biomarker-driven adjuvant therapy options, address the optimal sequencing of local and systemic treatments, and define how thoracic radiotherapy should be modified in this era of adjuvant therapy.

Neoadjuvant treatment strategies for early-stage resectable non-small cell lung cancer (NSCLC) are evolving with the introduction of immune checkpoint inhibitors. While traditional neoadjuvant chemotherapy has offered modest survival benefit, recent trials show that combining chemotherapy with immunotherapy significantly increases pathologic complete response rates and event-free survival, without raising perioperative risks. Ongoing research aims to refine biomarker-driven strategies and integrate advanced tools to better personalize treatment. While long-term survival data are still maturing, current evidence suggests that neoadjuvant chemoimmunotherapy is a significant advancement in the multimodal management of resectable NSCLC and a likely cornerstone of future standard care for early-stage disease.

Lung cancer, particularly non-small cell lung cancer (NSCLC), remains a leading cause of cancer mortality worldwide. Recent advances incorporate immune checkpoint inhibitors with chemotherapy in neoadjuvant and perioperative settings, significantly improving pathologic response and survival outcomes. Landmark phase III trials demonstrate increased complete response rates and prolonged event-free and overall survival, especially in programmed death-ligand 1 (PD-L1)-positive tumors. Ongoing studies aim to optimize treatment duration, assess the role of adjuvant immunotherapy, and explore biomarkers like circulating tumor DNA for personalized therapy and de-escalation. These developments are transforming the management of locally advanced NSCLC, but further research is required to refine patient selection, tailor treatment intensity and develop predictive biomarkers for a personalized care.

In early-stage non-small cell lung cancer (eNSCLC), immune checkpoint inhibitor (ICI) monotherapy without chemotherapy remains investigational and unapproved. Phase 2 neoadjuvant IO only trials established key early response markers (major pathologic regression, pathologic complete response, and objective response rate), clarifying the contributions of ICI monotherapy and CT-ICI. CT-ICI showed superior pathologic outcomes and became the preferred strategy in phase 3 trials. While pCR is a useful early efficacy marker, FDA approval still requires long-term outcomes such as event-free or overall survival. ICI monotherapy appears safe and well tolerated. Chemotherapy-free dual ICI regimens remain investigational.

This article examines the current role of surgery in stage IV non-small cell lung cancer (NSCLC). While management of patients with metastatic NSCLC has typically been limited to palliation of symptoms and efforts toward modest life prolongation, advances in tumor molecular profiling and systemic therapies have resulted in demonstrable survival benefits. Moreover, surgical resection in appropriately selected patients with adequate functional status and controllable metastatic disease has the potential to impact survival and quality of life outcomes as part of a multidisciplinary treatment paradigm. Ongoing prospective trials will address remaining gaps regarding optimal timing, patient selection, and procedural nuances.

This article will highlight how we consider tailored treatment to the needs of the individual patients in all phases of lung transplant care: preoperative, intraoperative, and postoperative.

This article explores the evolution and application of precision medicine within thoracic care, emphasizing its potential to enhance diagnosis, treatment, and prognosis by integrating genetic, environmental, sociocultural, and technological data. Key areas include the management of benign lung diseases-such as differentiating benign from malignant nodules and treating interstitial lung diseases-along with thoracic trauma and chest wall disorders. Despite promising advancements, challenges like data integration, infrastructural needs, and multidisciplinary collaboration remain. The article underscores that as these hurdles are addressed, precision medicine is poised to become a cornerstone of personalized thoracic care, ultimately improving outcomes and patient participation.

Precision medicine has transformed cancer care by tailoring treatments to the molecular profiles of tumors. While advances have been significant in common cancers, rare malignancies of the chest including primary chest wall tumors, mesothelioma, mediastinal germ cell tumors, and thymic epithelial tumors have progressed more slowly due to their rarity and heterogeneity. Unique biological alterations in these tumors offer opportunities for targeted therapies, which may enhance surgical outcomes and improve survival. This article reviews the evolving precision medicine landscape for these thoracic tumors, highlighting current strategies and future directions in both neoadjuvant and adjuvant settings.

This review article outlines how precision medicine is transforming lung cancer care through advanced screening, diagnostics, and personalized therapies. It covers innovations in imaging, biopsy, and intraoperative techniques, as well as the growing role of immunotherapy and targeted treatments. The article emphasizes minimally invasive surgery, tailored resection strategies, and the integration of artificial intelligence to improve outcomes. Overall, it highlights the importance of multidisciplinary, individualized approaches to improve lung cancer management and address health disparities.

Recent advancements in diagnostic tools have revolutionized the management of benign esophageal diseases, such as gastroesophageal reflux diseaseGERD, achalasia, and Barrett's esophagus (BE). Technologies such as High-Resolution Impedance Manometry (HRIM), Transoral Incisionless Fundoplication (TIF), EndoFLIP, and Volumetric Laser Endomicroscopy (VLE) have significantly enhanced the precision of diagnosing esophageal abnormalities. These innovations allow for real-time visualization and accurate monitoring of esophageal function, leading to more personalized and effective treatments. The integration of artificial intelligence (AI) and machine learning has further improved diagnostic capabilities. AI tools have advanced the detection of dysplasia and neoplasia in esophageal conditions, boosting early detection and diagnostic accuracy. Wide-area transepithelial sampling and tissue pathology systems powered by AI enable the identification of subtle lesions that might otherwise go unnoticed. Additionally, AI-driven algorithms enhance endoscopic imaging, minimizing the risk of missed diagnoses and providing more accurate results. Social determinants of health, such as income, education, and health care access, play a crucial role in the diagnosis, treatment, and outcomes of benign esophageal diseases. Disparities in health care access, particularly in underserved or rural areas, exacerbate health inequities and highlight the need for equitable health care policies. Addressing these disparities can improve early detection and treatment, ensuring that vulnerable populations receive the necessary care. This article will explore 5 key innovations in the management of benign esophageal diseases: HRIM, TIF, EndoFLIP, VLE, and the use of AI in detecting BE. It will also examine how the integration of these technologies has transformed the management of conditions such as achalasia, hiatal hernias, GERD, and BE.

Esophageal cancer, ranking 18th in incidence and 14th in mortality in the United States, has a low 5-year survival rate of around 20%. The 2 main histologic subtypes are esophageal adenocarcinoma, prevalent in Western countries and linked to obesity and gastroesophageal reflux disease, and esophageal squamous cell carcinoma, more common worldwide and associated with lifestyle risk factors like tobacco and alcohol. Accurate staging using endoscopic ultrasound, computed tomography, and PET scans guides treatment decisions, with multimodal approaches including surgery, chemoradiotherapy, and systemic therapies. Ongoing research into molecular targets and immunotherapies promises further improvements in management and survival for esophageal cancer patients.

The field of cardiothoracic surgery has been at the forefront of advances in precision medicine over the past 2 decades. However, there remain ethical challenges to precision medicine in practice, where clinicians struggle to distill new discoveries to a minority of patients who may benefit. The majority of research done on molecular and genetic characterization of disease processes has been in white and male patients, causing racial and gender disparities to persist. An ethical implementation of precision medicine requires an understanding of these challenges and a willingness to engage patients as stakeholders with clinicians and scientists in precision medicine advances.