Although infrequent, immunotherapy can lead to systemic inflammation and subsequent adverse outcomes in patients with head and neck cancer. There is sparce literature on the effect of preoperative immunotherapy on complications in patients undergoing head and neck cancer surgery.
We aim to compare surgical, medical, and overall complication rates in patients receiving neoadjuvant immunotherapy versus upfront surgery. We aim to evaluate factors predicting increased complication rate in our cohort.
Methods: We retrospectively reviewed patients undergoing ablation and free flap reconstruction or transoral robotic surgery (TORS) for primary head and neck squamous cell carcinoma (HNSCC) at a tertiary institution between 2017 – 2021. Rate of complications were compared between both groups. Variables that were found to be significant at the α = 0.05 level in the univariable model were considered for the multivariable regression analysis to estimate odds ratio (OR).
Results: 508 patients met inclusion criteria. Free flap reconstruction constituted 27.4% of patients and TORS constituted 72.6% of patients. Neoadjuvant immunotherapy was administered in 87/508 (17.1%) of patients. Durvalumab was administered in 22 patients and Nivolumab in 65 patients. Patients receiving neoadjuvant immunotherapy were significantly less likely to have lymph node metastasis (66.7% vs 77.2%, p = 0.043) and had decreased rates of lymphovascular invasion (LVI) (17.2% vs 33.5%, p =0.003) and perineural invasion (PNI) (18.4% vs 29.5%, p = 0.036) compared to patients undergoing upfront surgery. There was no statistically significant difference in surgical (20.7% vs 21.9%, p = 0.811), medical (10.3% vs 6.4%, p = 0.193), or overall complications (25.3% vs 25.9%, p = 0.907) between patients receiving neoadjuvant immunotherapy and upfront surgery. Predictors of increased overall complications included non-white race (OR, 2.32; 95% CI, 1.31 – 4.10; p = 0.004), advanced pathologic T classification (T4 versus T1; OR, 4.17; 95% CI, 1.11 – 15.7; p = 0.035), and current/former smoking history (OR, 2.25; 95% CI, 1.40 – 3.62; p < 0.001).
Conclusions: Neoadjuvant immunotherapy does not increase risk of overall complications. Definitive surgery can be conducted safely after neoadjuvant immunotherapy.