Perioperative immunotherapy has evolved into a novel therapeutic strategy for early-stage, resectable NSCLC, maximizing the efficacy of immunotherapy when the primary tumor is still present with a high neoantigen burden. Perioperative immunotherapy also allows the use of preoperative pathology as a guide for postoperative care and offers a pathway to potential surgical intervention due to tumor shrinkage for those who are not initially eligible for surgery. Clarifying the rationale behind perioperative immunotherapy in this context is crucial for optimizing treatment strategies and outcomes.