Neoadjuvant checkpoint inhibition combined with chemotherapy has demonstrated a pathologic complete response rate of 17% to 41% in patients with locally advanced nonsmall cell lung cancer. Following neoadjuvant immunotherapy, a major pathologic response occurs in 30% to 65% of patients, indicating significant tumor reduction. Surgeons face challenges such as unpredictable rates of dense hilar fibrosis and altered tissue planes, which can affect the surgical strategy. While minimally invasive techniques remain a viable option, they demand careful patient selection and a low threshold for conversion to more invasive surgical methods when necessary.