Value in Modern Thoracic Oncology: Perioperative Immunotherapy, Image‑Guided Surgery, and Comparative Effectiveness

The field of thoracic oncology is undergoing a profound transformation with the integration of perioperative immunotherapy and targeted therapies, advancements in image-guided minimally invasive surgery, and the adoption of hybrid operating room workflows. As recent studies demonstrate the clinical impact of neoadjuvant and perioperative systemic treatments on pathologic response and survival, key questions arise regarding optimal patient selection, the real-world value of emerging technologies, and the sustainability of innovation amid rising healthcare costs. Salvage surgery after immunotherapy, intraoperative near-infrared molecular imaging, and advanced localization techniques exemplify cutting-edge practices whose effectiveness and economic implications demand rigorous multidisciplinary evaluation. Despite growing evidence supporting these approaches, debates persist around comparative effectiveness, equitable access, procedure choice, and resource allocation - particularly as healthcare systems strive to deliver both clinical excellence and value-based care. This Research Topic aims to bridge clinical advancement with economic sustainability in modern thoracic oncology. We seek to clarify how perioperative immunotherapy, innovative surgical strategies, and image-guided interventions influence not only oncologic outcomes, but also cost-effectiveness, patient-reported outcomes, access, and system-wide efficiency. Key objectives include assessing the comparative effectiveness of minimally invasive and precision-guided resections versus alternative modalities, unraveling the value of salvage surgery post-immunotherapy, and quantifying real-world financial, pragmatic, and policy impacts. We encourage research that contextualizes clinical benefit within broader value frameworks and that supports decision-making for clinicians, administrators, payers, and health policy leaders. We welcome original research, systematic reviews, clinical trials with prespecified economic or PRO endpoints, and perspectives on:- Perioperative and neoadjuvant immunotherapy/targeted therapies in resectable NSCLC: clinical effectiveness, comparative value, and cost-utility- Salvage thoracic surgery after immunotherapy or targeted therapy: patient selection, outcomes, resource utilization, and budget impact- Image-guided minimally invasive surgery and hybrid‑OR workflows: advancements, comparative effectiveness, PROs, capital and operational costs- Near-infrared molecular imaging and localization: incremental benefits and health-economic implications- Equity and access: regional, payer, and system-level barriers to high-value interventions- Multicenter registries, pragmatic trials, and meta-analyses incorporating economic outcomes- Implementation science and policy strategies for sustainable, equitable adoption of novel surgical and perioperative pathwaysDr. María Rodríguez received financial support from Ethicon, Abex/Intuitive and AstraZeneca. The other Topic Editors declare no competing interests with regard to the Research Topic subject. Topic editors: Francesco Guerrera, Pietro Bertoglio, Maria Rodriguez Source: https://www.frontiersin.org/research-topics/73015/value-in-modern-thoracic-oncology-perioperative-immunotherapy-image-guided-surgery-and-comparative-effectiveness