Objective To investigate the correlation between neoadjuvant chemotherapy and short-term postoperative complications in patients with locally advanced oral squamous cell carcinoma (OSCC).

Methods　Retrospectively analyze the clinical data set of patients with locally advanced OSCC who underwent surgical treatment following two cycles of TPF neoadjuvant chemotherapy at Peking University School and Hospital of Stomatology between July 2023 and December 2024. Propensity score matching was used to enroll patients who underwent direct surgical treatment during the same period and matched in baseline characteristics as controls, at a 1∶1 ratio. The differences in perioperative parameters and postoperative complications between the neoadjuvant chemotherapy group and the direct surgery group were assessed.

Results　A total of 74 patients were included in the analysis, comprising 37 in the neoadjuvant chemotherapy group and 37 in the direct surgery group. In the neoadjuvant chemotherapy group, preoperative haemoglobin levels, red blood cell counts and albumin levels, as well as surgical duration and tracheostomy rates, were significantly lower than in the direct surgery group (P < 0.05); however, there was an increased requirement for postoperative blood and human albumin transfusions. No statistically significant differences were observed between the two groups in the incidence of short-term postoperative complications such as wound infection, haematoma, pulmonary infection, or deep vein thrombosis of the lower limbs (P > 0.05).

Conclusion　Neoadjuvant chemotherapy did not increase perioperative complication rates in patients with locally advanced OSCC. Rigorous preoperative assessment and standardised perioperative management should be implemented throughout the treatment.

1.   Amit M, Yen TC, Liao CT, et al. Improvement in survival of patients with oral cavity squamous cell carcinoma: an international collaborative study[J]. Cancer, 2013, 119(24): 4242-4248.

2.   Chow LQM. Head and neck cancer[J]. N Engl J Med, 2020, 382(1): 60-72.

3.   Tan Y, Wang Z, Xu M, et al. Oral squamous cell carcinomas: state of the field and emerging directions[J]. Int J Oral Sci, 2023, 15(1): 44.

4.   D'cruz AK, Vaish R, Dhar H. Oral cancers: current status[J]. Oral Oncology, 2018, 87: 64-69.

5.   Amaral MN, Faísca P, Ferreira HA, et al. Current insights and progress in the clinical management of head and neck cancer[J]. Cancers (Basel), 2022, 14(24).

6.   Kim D, Li R. Contemporary treatment of locally advanced oral cancer[J]. Curr Treat Options Oncol, 2019, 20(4): 32.

7.   Tam S, Araslanova R, Low TH, et al. Estimating survival after salvage surgery for recurrent oral cavity cancer[J]. JAMA Otolaryngol Head Neck Surg, 2017, 143(7): 685-690.

8.   Malik A, Vishnoi K, Noronha V, et al. A nuanced review of neoadjuvant therapies in oral cancer[J/OL]. Expert Rev Anticancer Ther, 2025, 25(5): 499-515.

9.   Licitra L, Grandi C, Guzzo M, et al. Primary chemotherapy in resectable oral cavity squamous cell cancer: a randomized controlled trial[J]. J Clin Oncol, 2003, 21(2): 327-333.

10.  Zhong LP, Zhang CP, Ren GX, et al. Randomized phase Ⅲ trial of induction chemotherapy with docetaxel, cisplatin, and fluorouracil followed by surgery versus up-front surgery in locally advanced resectable oral squamous cell carcinoma[J]. J Clin Oncol, 2013, 31(6): 744-751.

11.  Zhong LP, Zhang CP, Ren GX, et al. Long-term results of a randomized phase Ⅲ trial of TPF induction chemotherapy followed by surgery and radiation in locally advanced oral squamous cell carcinoma[J]. Oncotarget, 2015, 6(21): 18707-18714.

12.  Ju WT, Liu Y, Wang LZ, et al. Phase Ⅲ trial of docetaxel cisplatin 5-fluorouracil induction chemotherapy for resectable oral cancer suggests favorable pathological response as a surrogate endpoint for good therapeutic outcome[J]. Cancer Commun (Lond), 2021, 41(3): 279-283.

13.  Chaukar D, Prabash K, Rane P, et al. Prospective phase Ⅱ open-label randomized controlled trial to compare mandibular preservation in upfront surgery with neoadjuvant chemotherapy followed by surgery in operable oral cavity cancer[J]. J Clin Oncol, 2022, 40(3): 272-281.

14.  Huang Y, Sun J, Li J, et al. Neoadjuvant immunochemotherapy for locally advanced resectable oral squamous cell carcinoma: a prospective single-arm trial (Illuminate Trial)[J]. Int J Surg, 2023, 109(8): 2220-2227.

15.  Cracchiolo JR, Starc MT, Wong RJ, et al. Defining response-adapted surgery after neoadjuvant therapy in oral cavity cancer[J]. Oral Oncology, 2025, 165: 107349.

16.  Lee TL, Wei PY, Yang MH, et al. Tongue conservation treatment for oral tongue squamous cell carcinoma with induction chemotherapy, surgery, and risk-adapted adjuvant therapy: a phase II trial[J]. Cancer Rep (Hoboken), 2021, 5(2): e1456.

17.  Joshi P, Joshi A, Prabhash K, et al. Comparison of postoperative complications in advanced head and neck cancer patients receiving neoadjuvant chemotherapy followed by surgery versus surgery alone[J]. Indian J Med Paediatr Oncol, 2015, 36(4): 249-254.

18.  Kiong KL, Lin FY, Yao CMKL, et al. Impact of neoadjuvant chemotherapy on perioperative morbidity after major surgery for head and neck cancer[J]. Cancer, 2020, 126(19): 4304-4314.

19.  Crawford J, Herndon D, Gmitter K, et al. The impact of myelosuppression on quality of life of patients treated with chemotherapy[J]. Future Oncol, 2024, 20(21): 1515-1530.

20.  Bodensteiner DC, Doolittle GC. Adverse haematological complications of anticancer drugs. Clinical presentation, management and avoidance[J]. Drug Saf, 1993, 8(3): 213-224.

21.  Bozzini C, Busti F, Marchi G, et al. Anemia in patients receiving anticancer treatments: focus on novel therapeutic approaches[J]. Front Oncol, 2024, 14: 1380358.

22.  Lee JI, Kwon M, Roh JL, et al. Postoperative hypoalbuminemia as a risk factor for surgical site infection after oral cancer surgery[J]. Oral Diseases, 2014, 21(2): 178-184.