In recent years, the introduction of immune checkpoint inhibitors has significantly reshaped the therapeutic landscape for non-small cell lung cancer (NSCLC). Neoadjuvant immunotherapy (as monotherapy or in combination with chemotherapy) can significantly improve pathological response rates and has also demonstrated survival benefits when utilized within a comprehensive treatment regimen in combination with surgery. However, the tumor microenvironment remodeling induced by immunotherapy and immune-related adverse events present new challenges for surgical treatment strategies. This article addresses key issues in the surgical management of NSCLC in the context of neoadjuvant immunotherapy, focusing on three phases: preoperative, intraoperative, and postoperative, to explore the impact of immunotherapy on the selection of the time to surgery (TTS) and the optimal TTS, whether immunotherapy increases the difficulty and complexity of surgery, and whether immunotherapy affects the risk of perioperative complications. The aim is to provide guidance for surgical decision-making in clinical practice and to establish a foundation for future research directions.