Why and When Do We Invasively Restage After Neoadjuvant Chemoimmunotherapy?

This article addresses the evolving role of invasive mediastinal restaging in managing resectable stage II and III NSCLC in the era of neoadjuvant chemoimmunotherapy. It emphasizes that while invasive restaging is not routinely required for all patients after neoadjuvant therapy, it remains essential in cases with suspected disease progression—particularly to exclude new N3 status or differentiate between true disease progression and benign nodal immune flare. The authors underscore that surgical resection continues to be a critical component of curative-intent treatment, even for patients with persistent N2 disease, due to the lack of definitive evidence supporting radiation-based or systemic-only alternatives in such scenarios.  This article is significant to the cardiothoracic surgery community as it highlights the need for multidisciplinary decision-making and ongoing research to refine treatment strategies. This article also provides practical insights into integrating novel therapeutic paradigms with surgical care to optimize outcomes in NSCLC.