ASO Editorial: Lymph Node Dissection in the Immunotherapy Era: Friend or Foe?

The emergence of immunotherapy has transformed the management of resectable non-small cell lung cancer (NSCLC) and renewed interest in the relationship between surgery and antitumor immunity. Among the questions raised by this therapeutic evolution is whether lymph node dissection, a longstanding component of oncologic resection and pathologic staging, may influence the effectiveness of immune checkpoint inhibition through disruption of tumor-draining lymph node networks that are critical for antigen presentation and T cell priming. This question lies at the intersection of two enduring principles in thoracic oncology: the importance of high-quality nodal assessment and the growing recognition that lymphoid structures play a central role in mediating immune response to cancer therapies. As mechanistic understanding of tumor immunology continues to evolve, hypotheses have emerged suggesting that operative decisions may influence subsequent treatment efficacy. In this perspective, the authors examine the historical debate surrounding the extent of lymph node assessment in NSCLC, discuss emerging immunotherapy-era considerations, and explore the challenges of translating mechanistic observations into clinical practice. They argue that biologic plausibility, although fundamental, must ultimately be interpreted alongside clinical and epidemiologic evidence to guide contemporary surgical decision-making.