[Oncologic surgery in the context of immunotherapy, neoadjuvant treatment and HPV : Clinical, immunological and...

Head and neck oncological surgery has long been guided by stable therapeutic principles; however, advances in tumor immunology, the emergence of neoadjuvant immunotherapy and the distinct biology of human papillomavirus (HPV)-associated carcinomas are driving a paradigm shift. This article summarizes current developments and underlying biological mechanisms, focusing on biomarkers for patient selection and response assessment. Beyond conventional radiological criteria, immunopathological parameters are gaining relevance for monitoring and evaluating treatment efficacy. Despite immuno-oncological progress, surgery remains a cornerstone but is evolving into an integrated component of multimodal treatment strategies. With the approval of perioperative pembrolizumab following the positive Keynote-689 results, neoadjuvant therapy in head and neck cancer is becoming a clinical reality, heralding a new era in head and neck oncological surgery.