Wound healing and recurrence in head and neck cancer: a narrative review

Abstract

There is a growing body of evidence showing that the postoperative wound healing response shares molecular machinery with tumor pathways. Within larger surgical fields such as breast or colorectal cancer, strong preclinical and clinical evidence exists demonstrating a link between postoperative wound complications and cancer recurrence. Head and neck surgery represents a unique landscape with high rates of surgical site infections (SSIs; 20–30%), driven in part by inherent wound contamination from the aerodigestive tract, in addition to prolonged operative times, malnutrition, smoking, and poor overall health. Despite this, studies addressing postoperative wound healing and head and neck cancer (HNC) recurrence remain fragmented at best, with studies demonstrating significant heterogeneity and conflicting results. A thorough understanding of the oncologic implications of wound complications in HNC is vitally important to improve patient outcomes and identify novel therapeutic strategies. This narrative review seeks to synthesize preclinical and clinical studies linking the postoperative wound environment to HNC recurrence. We also seek to highlight emerging approaches to optimize postoperative wound healing for an oncologic benefit, including the role of surgical drain fluid as a novel bioresource, alternative reconstructive hardware, the role of neoadjuvant immunotherapy, and emerging biomaterials.