Global awareness and integration of immunotherapy among thoracic surgeons: a multicenter survey study

SUMMARY OBJECTIVE: Lung cancer is the leading cause of cancer-related mortality, with non-small cell lung cancer accounting for most cases. Surgery remains the primary treatment for early-stage non-small cell lung cancer, while advanced disease requires multimodal strategies. Immunotherapy, particularly immune checkpoint inhibitors targeting programmed cell death protein-1, programmed death-ligand 1, and cytotoxic T-lymphocyte-associated protein 4, has significantly improved survival and is increasingly incorporated into neoadjuvant and adjuvant settings. The aim of the study was to evaluate thoracic surgeons’ awareness, perceptions, and integration of immunotherapy in surgical practice. METHODS: A cross-sectional survey was conducted among 64 thoracic surgeons from 19 countries to assess their perspectives, challenges, and regional disparities in immunotherapy adoption. Statistical analyses examined associations between perceptions and variables such as specialty, experience, hospital type, and geographic region. RESULTS: Perceptions of immunotherapy did not differ significantly by specialty, experience, hospital type, or geographic location. However, significant associations were observed between years of experience and hospital type, as well as surgical specialty and geographic region. Key barriers included cost, lack of standardized guidelines, and challenges in multidisciplinary coordination. Surgeons in low- and middle-income countries reported greater difficulties in drug access and institutional infrastructure. The majority of participants (85%) expressed a need for further training, highlighting the importance of structured education programs and enhanced collaboration between surgical and medical oncology teams. CONCLUSION: While immunotherapy is widely accepted among thoracic surgeons, challenges related to education, accessibility, and implementation persist. Addressing these barriers through global initiatives, cost-effective policies, and multidisciplinary cooperation is essential for optimizing immunotherapy integration in thoracic surgery and improving outcomes for non-small cell lung cancer patients.