Wound healing in cancer patients under immunotherapy

Abstract

This comprehensive review examines the impact of cancer immunotherapies on wound healing, focusing on recent clinical evidence. While most cancer patients on immunotherapy heal surgical and accidental wounds without significant impairment, immune system alterations can sometimes delay healing or cause unique wound pathologies. Neoadjuvant immunotherapy before complex surgeries has shown higher wound complication rates in some cohorts, suggesting careful patient selection is needed. Immune checkpoint inhibitors don't typically increase general surgical complication rates, offering reassurance for most procedures. However, immunotherapy can directly cause wounds through immune-related adverse events like bullous pemphigoid or pyoderma gangrenosum, requiring specialized management. For malignant wounds, immunotherapy offers potential benefits by treating the underlying cancer. Management strategies include preoperative planning, careful surgical technique, close postoperative monitoring, and multidisciplinary collaboration. Despite adding complexity to wound healing, immunotherapy's cancer control benefits typically outweigh risks. With appropriate strategies and vigilance for impaired healing or unusual wound presentations, most patients can undergo surgery safely while continuing immunotherapy. Further research is needed to develop evidence-based guidelines for perioperative immunotherapy management.

Keywords: immune checkpoint inhibitors; immune-related adverse events; immunotherapy; surgical complications; wound healing.