AB191. SOH25_AB_243. The perioperative patient on immunotherapy: a narrative review of what the surgeon needs to know

Background and Objective: Immune checkpoint inhibitors (ICI) have become the standard of care for many advanced and metastatic tumours. Neoadjuvant immunotherapy has the potential to reduce tumour volume preoperatively and potentially limit postoperative relapse. ICIs bring their own set of unique inflammatory side effects, now termed immune-related adverse events (irAEs). Due to the inhibition of cytotoxic T-lymphocyte antigen 4 or programmed cell death 1, ICIs hyperactivate the immune system, causing off-target toxicities, which in turn can affect all organ pathways and potentially lead to severe or fatal toxicities. The surgeon remains the primary caregiver to patients during the perioperative period. Here, we provide a review of irAEs with special interest pertaining to the operating surgeon, focusing on epidemiology, risk factors, presentation, diagnosis, and management for the most common irAEs that may present in the perioperative period. As immunotherapies combined with surgery emerge as a forefront treatment, surgeons must develop new skills to recognize irAEs and adopt a multidisciplinary approach to guide patient management.

Methods: A review of current literature was performed in order to evaluate current knowledge of complications associated with immunotherapy.

Findings: Whilst immunotherapy has important benefits there are side effects associated.

Conclusions: Over the past decade, there has been rapid progress in the development and use of ICIs. In this review, we provide a succinct review of the most common and challenging irAEs, with particular attention to the perioperative period for surgeons.

Keywords: Adverse events; immunotherapy; perioperative; surgery; surgical complications