Background Preoperative immunotherapy targeting PD-1/-L1 with chemotherapy induces histopathological responses and improves survival in patients with resectable non-small cell lung cancer (NSCLC). NEOpredict-Lung (NCT04205552) established the feasibility of dual blockade of PD-1 and LAG-3 immune checkpoints prior to curatively intended resection. Here we report extended follow-up, postoperative treatments and patterns of response and recurrence. Patients and methods Patients with resectable NSCLC (stages IB-IIIA) were randomized to receive two doses nivolumab (240 mg, arm A) with or without relatlimab (80 mg, arm B) every 2 weeks. Overall and disease-free survival (OS, DFS) rates, response and recurrence patterns and subsequent therapies were evaluated. Results 60 patients were enrolled from March 2020 to July 2022. The present analysis was conducted per December 2024 with a median follow-up of 37.4 months. 45 patients were alive without disease recurrence,15 patients recurred (4 locoregional and 11 metastatic), and 7 patients died. The 3-year OS and DFS rates were 88.4 % and 73.3 % in arm A and 88.9 % and 60.3 % in arm B. Patients achieving major pathological response (≤10 % viable tumor cells in resected NSCLC) trended towards better DFS (HR 0.35; 95 % CI, 0.1–1.19). Downstaging was confirmed in 53.3 % of patients in arm A and in 66.7 % of patients in arm B. Nodal downstaging occurred in 28.6 % of patients with nodal disease in arm A and in 66.7 % of patients in arm B. Conclusions Short course preoperative nivolumab with or without relatlimab showed encouraging efficacy and survival outcomes, which compare favorably with chemo-immunotherapy-based perioperative treatment regimens.