Abstract: With the advent of perioperative immunotherapy for non-small cell lung cancer (NSCLC), the management of anesthesia in thoracic surgery has become challenging. Different choices for anesthesia modalities and drugs affect immune function, tumor growth, and metastasis. Cancer immunotherapy with immune checkpoint inhibitors activates antitumor immunity, affecting local and systemic immune response. Anesthesia and immunotherapy may cause unpredictable interactions. This review examines the impact of anesthetic modalities and pharmaceuticals along with immunotherapy on the immune status and prognosis of NSCLC, offering new insights for their perioperative management in patients with NSCLC.