Immunotherapy during the Immediate Perioperative Period: A Promising Approach against Metastatic Disease

Elad Sandbank, Anabel Eckerling, Adam Margalit, Liat Sorski, Shamgar Ben-Eliyahu*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Tumor excision is a necessary life-saving procedure in most solid cancers. However, surgery and the days before and following it, known as the immediate perioperative period (IPP), entail numerous prometastatic processes, including the suppression of antimetastatic immunity and direct stimulation of minimal residual disease (MRD). Thus, the IPP is pivotal in determining long-term cancer outcomes, presenting a short window of opportunity to circumvent perioperative risk factors by employing several therapeutic approaches, including immunotherapy. Nevertheless, immunotherapy is rarely examined or implemented during this short timeframe, due to both established and hypothetical contraindications to surgery. Herein, we analyze how various aspects of the IPP promote immunosuppression and progression of MRD, and how potential IPP application of immunotherapy may interact with these deleterious processes. We discuss the feasibility and safety of different immunotherapies during the IPP with a focus on the latest approaches of immune checkpoint inhibition. Last, we address the few past and ongoing clinical trials that exploit the IPP timeframe for anticancer immunotherapy. Accordingly, we suggest that several specific immunotherapies can be safely and successfully applied during the IPP, alone or with supporting interventions, which may improve patients’ resistance to MRD and overall survival.

Original languageEnglish
Pages (from-to)7450-7477
Number of pages28
JournalCurrent Oncology
Issue number8
StatePublished - Aug 2023


FundersFunder number
Israel Cancer Research FundPG-20-106
Institute of Mental Hygiene3-17323
Ministry of Health, State of Israel


    • immediate perioperative period
    • immune checkpoint inhibitors
    • immunotherapy
    • surgery


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