[Surgical trials in head and neck cancer at the 2026 ASCO Annual Meeting]

At the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting, once again, only a small number of presentations focused primarily on surgery. Nevertheless, surgical questions could be seen to be becoming increasingly important within perioperative multimodal treatment concepts. The most relevant contributions were secondary analyses of the phase III KEYNOTE-689 and NIVOPOSTOP trials. These data showed that, despite a higher rate of documented R0 resection and a lower frequency of pathological high-risk features after neoadjuvant immunotherapy, no reduction in the extent of resection could yet be justified and that oncologically indicated neck dissection should not be limited when postoperative immunotherapy was planned. Randomised data on adjuvant radiotherapy after adequately performed surgery for pT1-2 pN0 oral cavity cancer further emphasised the importance of clearly defined surgical quality criteria. New data on mandibular, laryngeal and pharyngeal preservation after neoadjuvant treatment reported high rates of R0 resection and organ preservation. However, small cohorts, the absence of control groups and insufficiently standardised indications for surgery preclude changes in clinical practice. Histological analyses demonstrated heterogeneous regression patterns with residual tumour islands after neoadjuvant immunotherapy and argued against reducing surgical margins solely based on radiological response. Ongoing randomised trials of neck dissection, sentinel lymph node biopsy and salvage surgery were still recruiting.