Neoadjuvant Immunochemotherapy Reduces Major Wound Complications in Oral Cancer Surgery

Neoadjuvant immunochemotherapy (NICT) is emerging for locally advanced oral squamous cell carcinoma (OSCC), but its impact on postoperative wound healing remains undefined. We compared major wound complication rates between patients receiving NICT and those undergoing upfront surgery (US).

In this retrospective cohort study, 466 patients with resectable OSCC (NICT = 278, US = 188) were included. Propensity score matching (1:1) was performed using covariates influencing treatment selection and wound healing, yielding 145 balanced pairs. The primary outcome was the incidence of major wound complications (Clavien-Dindo ≥ III) within 90 postoperative days. Secondary outcomes included time-to-complete wound healing, length of stay, and delay to adjuvant therapy. Multivariable regression and Cox models were used for adjustment.

After matching, baseline and surgical characteristics were well-balanced (all SMD < 0.1). The incidence of major wound complications was significantly lower in the NICT group (15.2% vs. 24.8%; p = 0.041). In multivariable analysis, upfront surgery remained an independent predictor of complications (OR = 2.15, 95% CI: 1.16-4.02, p = 0.016). Time-to-complete healing was shorter in the NICT group (HR = 0.66, 95% CI: 0.47-0.92, p = 0.014). Patients receiving NICT also had a shorter median hospital stay (10 vs. 12 days, p = 0.008) and lower rates of adjuvant therapy delay (18.6% vs. 31.0%, p = 0.015). Pathological response to NICT and immune-related adverse events were not associated with wound outcomes.

In this matched analysis, NICT was associated with a significantly lower risk of major wound complications and faster healing compared to upfront surgery, supporting its perioperative safety and potential to improve surgical outcomes in locally advanced OSCC. Future prospective validation is required.