Immunotherapy, particularly immune checkpoint inhibitors (ICIs), has significantly advanced the management of head and neck cancers (HNCs), and is increasingly integrated into perioperative strategies. This review addresses perioperative considerations essential for HNC patients undergoing surgery following neoadjuvant or adjuvant ICIs. Key perioperative issues include the optimal timing of surgery relative to immunotherapy, recognition and management of immune-related adverse events (irAEs), potential wound healing complications, infection risks, and anesthesia considerations. Neoadjuvant ICIs administered approximately 3–6 weeks before surgery are feasible without substantial delays or increased morbidity. Adjuvant ICIs typically begin 4–8 weeks postoperatively once adequate healing occurs, with careful integration alongside standard postoperative therapies like radiotherapy and chemotherapy. Common irAEs, including dermatologic, endocrine, pulmonary, cardiac, gastrointestinal, and renal complications, necessitate targeted preoperative screening and proactive management strategies. Multidisciplinary coordination is essential to minimize perioperative risks, with standardized protocols recommended for patient assessment, intraoperative management, and postoperative monitoring. Current evidence suggests that immunotherapy, while posing unique perioperative challenges, does not substantially elevate surgical risks if adequately managed.
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