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However, real\u2010world data on perioperative morbidity and treatment adherence remain limited. This study aimed to assess the feasibility and safety of different neoadjuvant treatment approaches applied within daily clinical routine. We retrospectively analyzed patients with resectable stage II\u2013III non\u2010small cell lung cancer undergoing either neoadjuvant chemoimmunotherapy or chemotherapy\/chemoradiotherapy followed by curative surgical resection. Treatment groups were compared with respect to perioperative outcomes, radiologic and pathologic downstaging, and pathologic response. A total of 143 patients met the inclusion criteria, of whom 46 (32.2%) received chemoimmunotherapy and 97 (67.8%) were treated with chemotherapy prior to surgery. Adverse events leading to treatment discontinuation occurred in only two patients in the chemoimmunotherapy group and four patients in the chemotherapy group. Chemoimmunotherapy was associated with significantly higher rates of pathologic complete response (37.0% vs. 4.1%) and more pronounced nodal downstaging, with a higher proportion of patients achieving ypN0 status (76.1% vs. 34.0%). High tumoral PD\u2010L1 expression (\u2265\u200950%) and squamous cell carcinoma histology were independently associated with pathologic complete response. Real\u2010world treatment with neoadjuvant chemoimmunotherapy was feasible and resulted in improved response rates compared with chemotherapy, without increasing perioperative morbidity. Histology and high PD\u2010L1 expression may serve as predictors for complete pathologic response, although the predictive value of PD\u2010L1 requires confirmation in larger cohorts with more complete biomarker data.<\/jats:p>","DOI":"10.1002\/ijc.70789","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:31:58Z","timestamp":1791973918000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real\u2010World Experience With Multimodal Treatment of Resectable Stage\n                    <scp>II<\/scp>\n                    \u2013\n                    <scp>III<\/scp>\n                    Non\u2010Small Cell Lung Cancer: A Single Institutional Analysis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2080-4606","authenticated-orcid":false,"given":"Raffaella","family":"Griffo","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Thoraxklinik 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