This systematic review and meta-analysis evaluated the effectiveness of neoadjuvant chemoimmunotherapy compared to chemotherapy in patients with resectable non-small cell lung cancer (NSCLC). The study included 43 trials with 5431 patients, of which 8 were randomized clinical trials. The results showed that neoadjuvant chemoimmunotherapy was associated with improved overall survival (OS), event-free survival (EFS), major pathological response (MPR), and complete pathological response (pCR) compared to chemotherapy. Notably, for patients with baseline tumor PD-L1 levels less than 1%, neoadjuvant chemoimmunotherapy showed a significant benefit in EFS but not in OS. The study found that neoadjuvant chemoimmunotherapy was superior to chemotherapy across surgical, pathological, and efficacy outcomes. These findings suggest that patients with resectable NSCLC and tumor PD-L1 levels less than 1% may benefit from neoadjuvant chemoimmunotherapy. The study also highlighted the need for further research to determine whether the EFS benefit translates into an OS benefit as more data becomes available. The study included both randomized and non-randomized trials, and the results were pooled using a random-effects meta-analysis. The analysis showed that neoadjuvant chemoimmunotherapy was associated with a reduced risk of not undergoing surgery due to progression on therapy, although there was an increased risk of adverse events precluding surgery. The study also found that neoadjuvant chemoimmunotherapy was associated with improved resectability and a higher rate of RO resections without an increase in the rate of surgical adverse events or treatment-related adverse events. The study concluded that neoadjuvant chemoimmunotherapy was superior to neoadjuvant chemotherapy in terms of efficacy, pathological outcomes, and surgical resection rates. These findings are particularly relevant given the recent restriction by the European Medicines Agency of neoadjuvant chemoimmunotherapy to patients with PD-L1 levels of 1% or greater. Future studies should continue to assess the benefit of neoadjuvant chemoimmunotherapy by subgroup as OS data matures.This systematic review and meta-analysis evaluated the effectiveness of neoadjuvant chemoimmunotherapy compared to chemotherapy in patients with resectable non-small cell lung cancer (NSCLC). The study included 43 trials with 5431 patients, of which 8 were randomized clinical trials. The results showed that neoadjuvant chemoimmunotherapy was associated with improved overall survival (OS), event-free survival (EFS), major pathological response (MPR), and complete pathological response (pCR) compared to chemotherapy. Notably, for patients with baseline tumor PD-L1 levels less than 1%, neoadjuvant chemoimmunotherapy showed a significant benefit in EFS but not in OS. The study found that neoadjuvant chemoimmunotherapy was superior to chemotherapy across surgical, pathological, and efficacy outcomes. These findings suggest that patients with resectable NSCLC and tumor PD-L1 levels less than 1% may benefit from neoadjuvant chemoimmunotherapy. The study also highlighted the need for further research to determine whether the EFS benefit translates into an OS benefit as more data becomes available. The study included both randomized and non-randomized trials, and the results were pooled using a random-effects meta-analysis. The analysis showed that neoadjuvant chemoimmunotherapy was associated with a reduced risk of not undergoing surgery due to progression on therapy, although there was an increased risk of adverse events precluding surgery. The study also found that neoadjuvant chemoimmunotherapy was associated with improved resectability and a higher rate of RO resections without an increase in the rate of surgical adverse events or treatment-related adverse events. The study concluded that neoadjuvant chemoimmunotherapy was superior to neoadjuvant chemotherapy in terms of efficacy, pathological outcomes, and surgical resection rates. These findings are particularly relevant given the recent restriction by the European Medicines Agency of neoadjuvant chemoimmunotherapy to patients with PD-L1 levels of 1% or greater. Future studies should continue to assess the benefit of neoadjuvant chemoimmunotherapy by subgroup as OS data matures.