Artificial Intelligence in Oncologic Thoracic Surgery: Clinical Decision Support and Emerging Applications

Abstract

Artificial intelligence (AI) is rapidly reshaping thoracic surgery, advancing from decision support to the threshold of autonomous intervention. AI-driven technologies-including machine learning (ML), deep learning (DL), and computer vision-have demonstrated significant improvements in diagnostic accuracy, surgical planning, intraoperative navigation, and postoperative outcome prediction. In lung cancer and thoracic oncology, AI enhances imaging analysis, histopathological classification, and risk stratification, supporting multidisciplinary decision-making and personalized therapy. Robotic-assisted and AI-guided systems are optimizing surgical precision and workflow efficiency, while real-time decision-support tools and augmented reality are improving intraoperative safety. Despite these advances, widespread adoption is limited by challenges in algorithmic bias, data integration, regulatory approval, and ethical transparency. The literature emphasizes the need for multicenter validation, explainable AI, and robust governance frameworks to ensure safe and effective clinical integration. Future research should focus on digital twin technology, federated learning, and transparent AI outputs to further enhance reliability and accessibility. AI is poised to transform thoracic surgery, but responsible implementation and ongoing evaluation are essential for realizing its full potential. The aim of this review is to evaluate and synthesize the current landscape of artificial intelligence (AI) applications across the thoracic surgical pathway, from preoperative decision-support to intraoperative guidance and emerging autonomous interventions.