Reconsidering Surgical Strategy in the Era of Neoadjuvant Immunotherapy for Head and Neck Cancer

Neoadjuvant immunotherapy is increasingly incorporated into the management of resectable locally advanced mucosal head and neck squamous cell carcinoma, raising questions about its impact on surgical decision-making. Despite encouraging trial data, limitations in response assessment and evidence of heterogeneous tumor regression challenge the use of treatment response to guide surgical de-escalation. This commentary highlights current uncertainties and emphasizes the need for prospective evidence before response-adapted surgical strategies can be safely implemented.