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Perioperative Outcomes of Melanoma Patients Undergoing Surgery After Receiving Immunotherapy or Targeted Therapy

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Abstract

Background

Traditional chemotherapy agents adversely affect wound healing and need to be held prior to or after surgery. Immune checkpoint inhibitors (ICIs) and targeted agents are now standard of care for the several treatment cancers. We hypothesize that ICI and targeted therapy do not have similar adverse effects on perioperative outcomes.

Methods

We performed a review of melanoma patients undergoing surgery at an academic hospital between 2011 and 2019. All patients received ICI or targeted therapy ≤ 60 days prior to surgery, including palliative procedures. Preoperative performance status was assessed using Eastern Cooperative Oncology Group score and American Society of Anesthesiologists Classification System. Thirty-day complications were classified by Clavien–Dindo grade. No statistical comparisons were performed.

Results

Of 63 patients included in the analysis, 29 (46%) patients received ICI and 34 (54%) received targeted therapy with median of 14 days (IQR 5–27 days) between the last preoperative dose and day of surgery (ICI, median 18 days [IQR 13–34.5]; targeted therapy, median 7 days [IQR 3–22.25]). There were no perioperative mortalities. Among patients treated with ICI, 22 patients (76%) had no complications. Four patients had wound infections (2 readmitted), 1 had reoperation (hematoma) and 2 readmitted for other reasons (fever; volvulus). Among patients treated with targeted therapy, 25 patients (74%) had no complications. Seven patients had wound infections (none readmitted), 1 had reoperation (flap failure) and 1 had dehiscence (not treated).

Conclusions

Patients undergoing treatment with ICI or targeted therapies can safely undergo surgery without substantially increased risk of serious intraoperative and postoperative complications.

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Funding

Zeynep Eroglu has advisory board relationships with Array and Regeneron. She has received research funding from Novartis. Nikhil I. Khushalani has advisory board relationships with Bristol-Myers Squibb, EMD Serano, HUYA Bioscience International, Genentech and Regeneron. Joseph Markowitz has advisory board relationships with Array. He has also received research funding from Morphogenesis. Vernon K. Sondak has advisory board relationships with Merck, Bristol-Myers Squibb, Regeneron and Novartis and serves on Data Safety Monitoring Boards for Array, Bristol-Myers Squibb, Novartis, Polynoma and Pfizer. Jonathan S. Zager has advisory board relationships with Merck and Array. He is a member of the speaker’s bureau for Array. He also receives research funding from Amgen, Delcath Systems, Philogen, Provectus and Novartis. He consults Amgen, Delcath Systems and Philogen. He is also a member of the speaker’s bureau for Amgen and SunPharma.

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Authors and Affiliations

  1. Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA

    James Sun, Michael J. Carr, Zeynep Eroglu, Nikhil I. Khushalani, Joseph Markowitz, Jane L. Messina, Vernon K. Sondak & Jonathan S. Zager

  2. Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    Dennis A. Kirichenko & Joyce L. Chung

  3. Department of Anesthesiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA

    Sephalie Y. Patel

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  1. James Sun
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Correspondence to Sephalie Y. Patel.

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James Sun, Dennis A. Kirichenko, Joyce L. Chung, Michael J. Carr, Jane L. Messina and Sephalie Y. Patel declare that they have no conflicts of interest.

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Sun, J., Kirichenko, D.A., Chung, J.L. et al. Perioperative Outcomes of Melanoma Patients Undergoing Surgery After Receiving Immunotherapy or Targeted Therapy. World J Surg 44, 1283–1293 (2020). https://doi.org/10.1007/s00268-019-05314-2

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