Therapeutic Perspectives for the Perioperative Period in Oral Squamous Cell Carcinoma (OSCC).

Antoine Galmiche,Sylvie Testelin,Martial Ouendo,Zuzana Saidak,Jérémie Bettoni

doi:10.3389/froh.2021.764386

Abstract

The perioperative period is the relatively short window of time, usually measured in days or weeks, around the surgical procedure. Despite its short duration, this time period is of great importance for cancer patients. From a biological point of view, the perioperative period is complex. Synchronous with primary tumor removal, surgery has local and distant consequences, including systemic and local inflammation, coagulation and sympathetic activation. Furthermore, the patients often present comorbidities and receive several medical prescriptions (hypnotics, pain killers, anti-emetics, hemostatics, inotropes, antibiotics). Because of the complex nature of the perioperative period, it is often difficult to predict the oncological outcome of tumor resection. Here, we review the biological consequences of surgery of Oral Squamous Cell Carcinoma (OSCC), the most frequent form of primary head and neck tumors. We briefly address the specificities and the challenges of the surgical care of these tumors and highlight the biological and clinical studies that offer insight into the perioperative period. The recent trials examining neoadjuvant immunotherapy for OSCC illustrate the therapeutic opportunities offered by the perioperative period.

Highlights

We briefly address the specificities and the challenges of the surgical care of these tumors and highlight the biological and clinical studies that offer insight into the perioperative period
We discuss the challenges of the study of the perioperative period and the opportunities for therapeutic improvement against Oral Squamous Cell Carcinoma (OSCC) (Table 1)
It is recognized that the extent of surgical resection for OSCC is considered in view of the need to preserve phonation, deglutition and the overall quality of life

Summary

THE PERIOPERATIVE PERIOD AND ITS ONCOGENIC RELEVANCE

Surgical tumor removal is an essential procedure in cancer management, and for most patients it is the only curative procedure available. The aim of surgery is usually to achieve complete tumor removal with R0 clear surgical margins. Even in this situation the surgical procedure has multiple opposing influences on the oncological outcome. One positive effect of tumor debulking may come from reduced secretion of growth factors, cytokines and hormones by cancer cells, since these cells usually have an altered secretome with potential systemic consequences [3]. Due to the complex consequences of these simultaneous events, it is always difficult to reliably predict the oncological outcome of surgery. This uncertainty has led some authors to compare the perioperative period to a Russian roulette [4]. We discuss the challenges of the study of the perioperative period and the opportunities for therapeutic improvement against Oral Squamous Cell Carcinoma (OSCC) (Table 1)

THE DIFFICULTIES OF STUDYING THE PERIOPERATIVE PERIOD IN ORAL CAVITY TUMORS

Inflammation and Wound Healing

Bleeding and Coagulation

Stress coping procedures

Findings

Anesthesics and Analgesics