The role of immunotherapy in improving surgical outcomes: A literature review
Full Text (PDF)
Georgiana Bianca Constantin 1 * , Raul Mihailov 2 , Mădălin Guliciuc 2 , Cristina Șerban 2 , Iulian Constantin 2, Bogdan Ioan Ștefănescu 2
More Detail
1 Morphological and Functional Sciences Department, Faculty of Medicine and Pharmacy, Medical-Pharmaceutical Research Center, Dunarea de Jos University, Galati, ROMANIA2 Surgical Department, Faculty of Medicine and Pharmacy, Medical-Pharmaceutical Research Center, Dunarea de Jos University, Galati, ROMANIA* Corresponding Author
Abstract
Recent advances in various forms of immunotherapy have inaugurated a new era in multimodal cancer treatment. Immunotherapeutic interventions can significantly influence perioperative morbidity and overall survival among oncologic patients. Research interest in this field has expanded substantially and numerous studies have demonstrated that combining immunotherapy with surgery may confer benefits across diverse malignancies. This review aims to provide a comprehensive overview of these encouraging findings, emphasizing the value of this integrated therapeutic approach in contemporary oncologic practice.
License
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article Type: Review Article
ELECTRON J GEN MED, Volume 23, Issue 5, October 2026, Article No: em759
https://doi.org/10.29333/ejgm/19651
Publication date: 22 Oct 2026
Article Views: 18
Article Downloads: 12
Open Access References How to cite this articleReferences
- El-Tanani M, Rangraze I, Rabbani SA, Rizzo M, Parvez S, Khan AM. The role of immunotherapy in enhancing surgical outcomes for melanoma patients. World J Surg Surg Res. 2024;7:1567. PMid:41150456 PMCid:PMC12567567
- Desai A, Schwed K, Kalesinskas L, et al. Clinical outcomes of perioperative immunotherapy in resectable non-small cell lung cancer. JAMA Netw Open. 2025;8(6):e2517953. https://doi.org/10.1001/jamanetworkopen.2025.17953 PMid:40587130 PMCid:PMC12210081
- Barjot C, Gaillard T, Seban RD, et al. Impact of neoadjuvant immunotherapy on postoperative complications in oncoplastic breast cancer surgery. Eur J Surg Oncol. 2025;51(12):110511. https://doi.org/10.1016/j.ejso.2025.110511 PMid:41326217
- Sandbank E, Eckerling A, Margalit A, Sorski L, Ben-Eliyahu S. Immunotherapy during the immediate perioperative period: A promising approach against metastatic disease. Curr Oncol. 2023;30(8):7450-77. https://doi.org/10.3390/curroncol30080540 PMid:37623021 PMCid:PMC10453707
- Rajadurai CV, Gagnon G, Allard C, Malick M, Pavic M. Evaluating the efficacy of immunotherapy in fragile hospitalized patients. Curr Oncol. 2024;31(11):7040-50. https://doi.org/10.3390/curroncol31110518 PMid:39590149 PMCid:PMC11593166
- Loufopoulos P, Perivoliotis K, Chatziathanasiou D, Frountzas M, Sukha A, Alrebdi A, Eddama MMR, Kontovounisios C, Qiu S, Tekkis P. Immunotherapy-induced complete response in dMMR rectal cancer—A surgical dilemma? Cancers (Basel). 2025;17(19):3153. https://doi.org/10.3390/cancers17193153 PMid:41097680 PMCid:PMC12523431
- Muto Y, Fujimura T, Asano Y. Recent advances in immunotherapy for melanoma: Perspectives on the development of novel treatments: A mini review. Cancers (Basel). 2025;17(13):2265. https://doi.org/10.3390/cancers17132265 PMid:40647561 PMCid:PMC12248896
- Lewis CR, Samhouri Y, Sherry C, Dadgar N, Raj MS, Wagner PL. Current and future directions in immunotherapy for gastrointestinal malignancies. Int J Transl Med. 2025;5(3):33. https://doi.org/10.3390/ijtm5030033
- Metzger DA, Chahal Y, Watman O, et al. Immunotherapy plus surgery improves survival in microsatellite instability-high colon cancer with isolated peritoneal metastases. Cancers (Basel). 2025;17(21):3496. https://doi.org/10.3390/cancers17213496 PMid:41228288 PMCid:PMC12609588
- Kelly RJ, Ajani JA, Kuzdzal J, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med. 2021;384(13):1191-203. https://doi.org/10.1056/NEJMoa2032125 PMid:33789008
- Janjigian YY, Bendell J, Calvo E, et al. CheckMate-032 study: Efficacy and safety of nivolumab and nivolumab plus ipilimumab in patients with metastatic esophagogastric cancer. J Clin Oncol. 2018;36(28):2836-44. https://doi.org/10.1200/JCO.2017.76.6212 PMid:30110194
- Tieniber AD, Perez JE, Hanna AN, DeMatteo RP. Immunotherapy for GI malignancies, ready for prime time? Ann Surg Oncol. 2023;30(3):1787-93. https://doi.org/10.1245/s10434-022-12668-w PMid:36273054
- Dahiya DS, Kichloo A, Singh J, Albosta M, Lekkala M. Current immunotherapy in gastrointestinal malignancies. J Investig Med. 2021;69(3):689-96. https://doi.org/10.3390/ijtm5030033
- Andre T, Lonardi S, Wong M, et al. Nivolumab + ipilimumab combination in patients with DNA mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) metastatic colorectal cancer (mCRC): First report of the full cohort from CheckMate-142. J Clin Oncol. 2018;36(4_suppl):553. https://doi.org/10.1016/j.annonc.2022.06.008 PMid:35764271
- Cercek A, Lumish M, Sinopoli J, et al. PD-1 blockade in mismatch repair–Deficient, locally advanced rectal cancer. N Engl J Med. 2022;386(25):2363-76. https://doi.org/10.1056/NEJMoa2201445 PMid:35660797
- Ascierto PA, Addeo R, Cartenì G, et al. The role of immunotherapy in solid tumors: Report from the Campania Society of Oncology Immunotherapy (SCITO) meeting, Naples 2014. J Transl Med. 2014;12:291. https://doi.org/10.1186/s12967-014-0291-1 PMid:25331657 PMCid:PMC4209076
- Rizzo A, Ricci AD, Brandi G. Pemigatinib: Hot topics behind the first approval of a targeted therapy in cholangiocarcinoma. Cancer Treat Res Commun. 2021;27:00337. https://doi.org/10.1016/j.ctarc.2021.100337 PMid:33611090
- Naganuma A, Sakuda T, Murakami T, Aihara K, Watanuki Y, Suzuki Y, Shibasaki E, Masuda T, Uehara S, Yasuoka H. Microsatellite instability-high intrahepatic cholangiocarcinoma with portal vein tumor thrombosis successfully treated with pembrolizumab. Intern Med. 2020;59(18):2261-7. https://doi.org/10.2169/internalmedicine.4588-20 PMid:32536644 PMCid:PMC7578609
- Czink E, Kloor M, Goeppert B, et al. Successful immune checkpoint blockade in a patient with advanced stage microsatellite-unstable biliary tract cancer. Cold Spring Harb Mol Case Stud. 2017;3(5):a001974. https://doi.org/10.1101/mcs.a001974 PMid:28619747 PMCid:PMC5593153
- Li B, Chen H, Yang S, et al. Advances in immunology and immunotherapy for mesenchymal gastrointestinal cancers. Mol Cancer. 2023;22:71. https://doi.org/10.1186/s12943-023-01770-6 PMid:37072770 PMCid:PMC10111719
- Sriramulu S, Thoidingjam S, Speers C, Nyati S. Present and future of immunotherapy for triple-negative breast cancer. Cancers (Basel). 2024;16(19):3250. https://doi.org/10.3390/cancers16193250 PMid:39409871 PMCid:PMC11475478
- Blumenthal GM, Scher NS, Cortazar P, et al. First FDA approval of dual anti-HER2 regimen: Pertuzumab in combination with trastuzumab and docetaxel for HER2-positive metastatic breast cancer. Clin Cancer Res. 2013;19(18):4911-6. https://doi.org/10.1158/1078-0432.CCR-13-1212 PMid:23801166
- Sievers EL, Senter PD. Antibody-drug conjugates in cancer therapy. Annu Rev Med. 2013;64:15-29. https://doi.org/10.3390/molecules25204764 PMid:33081383 PMCid:PMC7587605
- Angom RS, Nakka NMR, Bhattacharya S. Advances in glioblastoma therapy: An update on current approaches. Brain Sci. 2023;13(11):1536. https://doi.org/10.3390/brainsci13111536 PMid:38002496 PMCid:PMC10669378
- Rahnea-Nita RA, Stoian AR, Anghel RM, et al. The efficacy of immunotherapy in long-term survival in non-small cell lung cancer (NSCLC) associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Life (Basel). 2023;13(6):1279. https://doi.org/10.3390/life13061279 PMid:37374062 PMCid:PMC10303290
- Mihailov R, Firescu D, Constantin GB, et al. Mortality risk stratification in emergency surgery for obstructive colon cancer – External validation of international scores, American College of Surgeon National Surgical Quality Improvement Program Surgical Risk Calculator (SRC) and the Dedicated Score of French Surgical Association (AFC/OCC Score). Int J Environ Res Public Health. 2022;19(20:13513. https://doi.org/10.3390/ijerph192013513 PMid:36294094 PMCid:PMC9603747
- Schena M, Battaglia AF, Trogu A. Immuno-checkpoint inhibitors in metastatic esophago-gastric cancer. J Thorac Dis. 2019;11(Suppl 3):S376-80. https://doi.org/10.21037/jtd.2018.12.71 PMid:30997225 PMCid:PMC6424743
- Rahnea-Nita RA, Corobcean N, Constantin GB, et al. Unexpected long-term survival and downstaging in oligometastatic non-small cell lung cancer treated with multimodal therapy. Jo Clin Med. 2025;14(10):3394. https://doi.org/10.3390/jcm14103394 PMid:40429388 PMCid:PMC12112489
- Kang Y-K, Boku N, Satoh T, et al. Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2): A randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;390(10111):2461-71. https://doi.org/10.1016/S0140-6736(17)31827-5 PMid:28993052
- Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): A randomised, open-label, phase 3 trial. Lancet. 2021;398(10294):27-40. https://doi.org/10.1016/S0140-6736(21)00797-2 PMid:34102137
- Overman MJ, McDermott R, Leach JL, et al. Nivolumab in patients with metastatic DNA mismatch repair-deficient or microsatellite instability-high colorectal cancer (CheckMate 142): An open-label, multicentre, phase 2 study. Lancet Oncol. 2017;18(9):1182-91. https://doi.org/10.1016/S1470-2045(17)30422-9 PMid:28734759
- Yau T, Park J-W, Finn RS, et al. Nivolumab versus sorafenib in advanced hepatocellular carcinoma (CheckMate 459): A randomised, multicentre, open-label, phase 3 trial. Lancet Oncol. 2022;23(1):77-90. https://doi.org/10.1016/S1470-2045(21)00604-5 PMid:34914889 PMCid:PMC10847200
- Li R, Liu Y, Liu Y, et al. Durvalumab plus gemcitabine/cisplatin/nab-paclitaxel in resectable biliary tract cancer: A phase II, single-arm, open-label study (DurGAP). J Clin Oncol. 2024;42:e16260. https://doi.org/10.1200/JCO.2024.42.16_suppl.e16260
- Shi G-M, Huang X-Y, Wu D, et al. Toripalimab combined with lenvatinib and GEMOX is a promising regimen as first-line treatment for advanced intrahepatic cholangiocarcinoma: A single-center, single-arm, phase 2 study. Signal Transduct Target Ther. 2023;8(1):106. https://doi.org/10.1038/s41392-023-01317-7 PMid:36928584 PMCid:PMC10020443
- Ott PA, Piha-Paul SA, Munster P, et al. Safety and antitumor activity of the anti-PD-1 antibody pembrolizumab in patients with recurrent carcinoma of the anal canal. Ann Oncol. 2017;28(5):1036-41. https://doi.org/10.1093/annonc/mdx029 PMid:28453692 PMCid:PMC5406758
- Forsythe SD, Erali RA, Sasikumar S, et al. Organoid platform in preclinical investigation of personalized immunotherapy efficacy in appendiceal cancer: Feasibility study. Clin Cancer Res. 2021;27(18):5141-50. https://doi.org/10.1158/1078-0432.CCR-21-0982 PMid:34210684
- Noy J, Chang A, Chow NP, et al. Outcomes of resectable locally advanced non-small cell lung cancer after neoadjuvant chemoimmunotherapy: A single institution experience. J Clin Med. 2025;14(3):988. https://doi.org/10.3390/jcm14030988 PMid:39941658 PMCid:PMC11818748
- Ćeriman Krstić V, Soldatović I, Gajić M, et al. Long-term outcomes in patients with locally advanced and metastatic non-small cell lung cancer with high PD-L1 expression. Curr Oncol. 2025;32(4):229. https://doi.org/10.3390/curroncol32040229 PMid:40277785 PMCid:PMC12025878
- Berényi G, Szabó D, Agócs G, et al. Impact of infection on survival outcomes in high-grade gliomas: A retrospective analysis of 26 cases in our fifteen-year experience—Janus faced phenomenon. Cancers (Basel). 2025;17(8):1348. https://doi.org/10.3390/cancers17081348 PMid:40282523 PMCid:PMC12025897
- Ostrom QT, Shoaf ML, Cioffi G, et al. National-level overall survival patterns for molecularly-defined diffuse glioma types in the United States. Neuro Oncol. 2023;6;25(4):799-807. https://doi.org/10.1093/neuonc/noac198 PMid:35994777
- Brastianos PK, Kim AE, Giobbie-Hurder A, et al. Phase 2 study of pembrolizumab in patients with recurrent and residual high-grade meningiomas. Nat Commun. 2022;13(1):1325. https://doi.org/10.1038/s41467-022-29052-7 PMid:35289329 PMCid:PMC8921328
- Kang J, Zhang C, Zhong WZ. Neoadjuvant immunotherapy for non-small cell lung cancer: State of the art. Cancer Commun. 2021;41(4):287-302. https://doi.org/10.1002/cac2.12153 PMid:33689225 PMCid:PMC8045926
- Wang Y-Q, Liu X-D, Bai W-L, Li S-Q. Identification of resectable N2 in NSCLC: A single center experience and review of the SEER database. Front Oncol. 2021;11:647546. https://doi.org/10.3389/fonc.2021.647546 PMid:33981606 PMCid:PMC8108988
- Wakelee H, Liberman M, Kato T, et al. Perioperative pmbrolizumab for early-stage non-small-cell lung cancer. N Engl J Med. 2023;389(6):491-503. https://doi.org/10.1056/NEJMoa2302983 PMid:37272513
- Liu W, Zhang T, Zhang Q, Li L, Xu C. A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer. BMC Pulm Med. 2022;22(1):490. https://doi.org/10.1186/s12890-022-02292-5 PMid:36582007 PMCid:PMC9798701
- Spicer JD, Cascone T, Wynes MW, et al. Neoadjuvant and adjuvant treatments for early stage resectable NSCLC: Consensus recommendations from the international association for the study of lung cancer. J Thorac Oncol. 2024;19(10):1373-414. https://doi.org/10.1016/j.jtho.2024.06.010 PMid:38901648
- Imyanitov EN, Yanus GA. Neoadjuvant therapy: Theoretical, biological and medical consideration. Chin Clin Oncol. 2018;7(6):55. https://doi.org/10.21037/cco.2018.09.05 PMid:30509077
- FDA. Pathological complete response in neoadjuvant treatment of high-risk early-stage breast cancer: Use as an endpoint to support accelerated approval. Available at: https://www.fda.gov/media/83507/download (Accessed: 13 June 2025).
- Sanber K, Rosner S, Forde PM, Marrone KA. Neoadjuvant immunotherapy for non-small cell lung cancer. BioDrugs. 2023;37(6):775-91. https://doi.org/10.1007/s40259-023-00614-5 PMid:37603233
- Matzner P, Sandbank E, Neeman E, Zmora O, Gottumukkala V, Ben-Eliyahu S. Harnessing cancer immunotherapy during the unexploited immediate perioperative period. Nat Rev Clin Oncol. 2020;17(5):313-26. https://doi.org/10.1038/s41571-019-0319-9 PMid:32066936
- Galuia M, Fedorova J, McHayleh W, Mamounas E, Ahmad S, Pavri S. Perioperative drug management of systemic therapies in breast cancer: A literature review and treatment recommendations. Curr Oncol. 2025;32(3):154. https://doi.org/10.3390/curroncol32030154 PMid:40136358 PMCid:PMC11941735
- Rugo HS, Bardia A, Marmé F, et al. Overall survival with sacituzumab govitecan in hormone receptor-positive and human epidermal growth factor receptor 2-negative metastatic breast cancer (TROPiCS-02): A randomised, open-label, multicentre, phase 3 trial. Lancet. 2023;402(10411):1423-33. https://doi.org/10.1016/S0140-6736(23)01245-X PMid:37633306
- Ackerman RS, Muncey AR, Aldawoodi NN, Kotha R, Getting REG. Cancer immunotherapies: What the perioperative physician needs to know. Curr Oncol Rep. 2022;24(4):399-414. https://doi.org/10.1007/s11912-022-01202-6 PMid:35141856 PMCid:PMC9056594
- Cortes J, Rugo HS, Cescon DW, et al. Pembrolizumab plus chemotherapy in advanced triple-negative breast cancer. N Engl J Med. 2022;387(3):217-26. https://doi.org/10.1056/NEJMoa2202809 PMid:35857659
- Robert C, Schachter J, Long GV, et al. Pembrolizumab versus ipilimumab in advanced melanoma. N Engl J Med. 2015;372(26):2521-32. https://doi.org/10.1056/NEJMoa1503093 PMid:25891173
- Eggermont AMM, Chiarion-Sileni V, Grob J-J, et al. Adjuvant ipilimumab versus placebo after complete resection of high-risk stage III melanoma (EORTC 18071): Arandomised, double-blind, phase 3 trial. Lancet Oncol. 2015;16(5):522-30. https://doi.org/10.1016/S1470-2045(15)70122-1 PMid:25840693
- Vitorakis N, Gargalionis AN, Papavassiliou KA, Adamopoulos C, Papavassiliou AG. Precision targeting strategies in pancreatic cancer: The role of tumor microenvironment. Cancers (Basel). 2024;16(16):2876. https://doi.org/10.3390/cancers16162876 PMid:39199647 PMCid:PMC11352254
- Kamath SD, Kalyan A, Kircher S, et al. Ipilimumab and gemcitabine for advanced pancreatic cancer: A phase Ib study. Oncologist. 2020;25(5):e808-15. https://doi.org/10.1634/theoncologist.2019-0473 PMid:31740568 PMCid:PMC7216436
- Zhang H, Ye L, Yu X, Jin K, Wu W. Neoadjuvant therapy alters the immune microenvironment in pancreatic cancer. Front Immunol. 2022;13:956984. https://doi.org/10.3389/fimmu.2022.956984 PMid:36225934 PMCid:PMC9548645
- André T, Shiu K-K, Kim TW, et al. Pembrolizumab in microsatellite-instability-high advanced colorectal cancer. N Engl J Med. 2020;383(23):2207-18. https://doi.org/10.1056/NEJMoa2017699 PMid:33264544 PMCid:PMC9646945
- Elez E, Siena S, Sartore-Bianchi A, et al. Efficacy and safety of atezolizumab plus bevacizumab in MSI-like metastatic colorectal cancer: A multicenter, single-arm, phase II, open-label clinical trial. ESMO Open. 2025;10(12):105892. https://doi.org/10.1016/j.esmoop.2025.105892 PMid:41337858 PMCid:PMC12720074
- Baimas-George M, Baker E, Kamionek M, et al. A complete pathological response to pembrolizumab following ex vivo liver resection in a patient with colorectal liver metastases. Chemotherapy. 2018;63(2):90-4. https://doi.org/10.1159/000487814 PMid:29621772
- Verset G, Borbath I, Karwal M, et al. Pembrolizumab monotherapy for previously untreated advanced hepatocellular carcinoma: Data from the open-label, phase II KEYNOTE-224 trial. Clin Cancer Res. 2022;28(12):2547-54. https://doi.org/10.1158/1078-0432.CCR-21-3807 PMid:35421228 PMCid:PMC9784157
- Sangro B, Chan SL, Kelley RK, et al. Four-year overall survival update from the phase III HIMALAYA study of tremelimumab plus durvalumab in unresectable hepatocellular carcinoma. Ann Oncol. 2024;35(5):448-57. https://doi.org/10.1016/j.annonc.2024.02.005 PMid:38382875
- Lo JH, Agarwal R, Goff LW, Heumann TR. Immunotherapy in biliary tract cancers: Current standard-of-care and emerging strategies. Cancers (Basel). 2023;15(13):3312. https://doi.org/10.3390/cancers15133312 PMid:37444422 PMCid:PMC10340362
- Kelley RK, Ueno M, Yoo C, et al. Pembrolizumab in combination with gemcitabine and cisplatin compared with gemcitabine and cisplatin alone for patients with advanced biliary tract cancer (KEYNOTE-966): A randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2023;401(10391):1853-65. https://doi.org/10.1016/S0140-6736(23)00727-4 PMid:37075781 PMCid:PMC12634726
How to cite this article
Vancouver
Constantin GB, Mihailov R, Guliciuc M, Șerban C, Constantin I, Ștefănescu BI. The role of immunotherapy in improving surgical outcomes: A literature review. ELECTRON J GEN MED. 2026;23(5):em759. https://doi.org/10.29333/ejgm/19651
APA
Constantin, G. B., Mihailov, R., Guliciuc, M., Șerban, C., Constantin, I., & Ștefănescu, B. I. (2026). The role of immunotherapy in improving surgical outcomes: A literature review. Electronic Journal of General Medicine, 23(5), em759. https://doi.org/10.29333/ejgm/19651
AMA
Constantin GB, Mihailov R, Guliciuc M, Șerban C, Constantin I, Ștefănescu BI. The role of immunotherapy in improving surgical outcomes: A literature review. ELECTRON J GEN MED. 2026;23(5), em759. https://doi.org/10.29333/ejgm/19651
Chicago
Constantin, Georgiana Bianca, Raul Mihailov, Mădălin Guliciuc, Cristina Șerban, Iulian Constantin, and Bogdan Ioan Ștefănescu. "The role of immunotherapy in improving surgical outcomes: A literature review". Electronic Journal of General Medicine 2026 23 no. 5 (2026): em759. https://doi.org/10.29333/ejgm/19651
Harvard
Constantin, G. B., Mihailov, R., Guliciuc, M., Șerban, C., Constantin, I., and Ștefănescu, B. I. (2026). The role of immunotherapy in improving surgical outcomes: A literature review. Electronic Journal of General Medicine, 23(5), em759. https://doi.org/10.29333/ejgm/19651
MLA
Constantin, Georgiana Bianca et al. "The role of immunotherapy in improving surgical outcomes: A literature review". Electronic Journal of General Medicine, vol. 23, no. 5, 2026, em759. https://doi.org/10.29333/ejgm/19651