With the advances in systemic therapy and radiotherapy, the life expectancy of patients battling cancer has increased. The oculofacial plastic surgeon should be aware of the potential impacts a patient in remission or one being actively treated may pose. The goal of this review is to discuss the considerations a surgeon should have in this patient population.
Methods
The authors performed a computerized search using PubMed, Embase, and Google Scholar. The search terms used were “chemotherapy AND surgery”, “immunotherapy AND surgery”, “radiotherapy AND surgery”, “nutrition AND surgery”, “(oculoplastic OR orbit OR eyelid OR lacrimal OR puncta) AND (chemotherapy OR immunotherapy OR radiotherapy)”, “(facial OR facial plastic OR oculoplastic) AND (chemotherapy OR immunotherapy OR radiotherapy)”, “(cancer OR malignancy) AND surgery”, “(cancer OR malignancy) AND (surgery OR surgical) complications”, “wound healing AND (cancer OR malignancy)”, “infection AND (cancer OR malignancy)”, “(bleeding OR blood loss) AND (cancer OR malignancy) AND surgery”, “(chemotherapy OR immunotherapy OR radiotherapy) AND wound healing”, “(chemotherapy OR immunotherapy OR radiotherapy) AND (bleeding OR blood loss)”, “(chemotherapy OR immunotherapy OR radiotherapy) AND infection”.
Results
A total of 89 articles, published from 1993 to 2023 in the English language or with English translations were included. Articles published earlier than 2000 were cited for foundational knowledge. References cited in the identified articles were also used to gather further data for the review.
Conclusions and Relevance
Patients who are being treated for cancer or are undergoing current treatment for cancer require special considerations. Systemic therapies and radiotherapy impact the physiology of patients and the integrity of tissue in ways that significantly impact surgical interventions. It is imperative for the oculofacial plastic surgeon to have a complete understanding on how a previous or current diagnosis of cancer can influence surgical outcomes.
Get full access to this article
View all access options for this article.
References
1.
HalpernMTYabroffKR. Prevalence of outpatient cancer treatment in the United States: estimates from the medical panel expenditures survey (meps). Cancer Invest2008; 26: 647–651.
BrinkHMBeexLV. Punctal and canalicular stenosis associated with systemic fluorouracil therapy. Report of five cases and review of the literature. Doc Ophthalmol1995; 90: 1–6.
4.
EomYBaekSKimHM,et al.Meibomian gland dysfunction in patients with chemotherapy-induced lacrimal drainage obstruction. Cornea2017; 36: 572–577.
5.
ParkJKimJBaekS. Clinical features and treatment outcomes of patients with tearing after chemotherapy. Eye (Lond)2019; 33: 746–753.
6.
VillamariaEDacyNPrestonA,et al.Ectropion following topical 5-fluorouracil treatment. Proc (Bayl Univ Med Cent)2023; 36: 249–250.
7.
Staso FDIGattazzoISalimbeniBT, et al.Treatment of capecitabine corneal Side effects with autologous blood-derived Serum eye drops. In Vivo2021; 35: 1881–1884. doi:https://doi.org/10.21873/invivo.12451
8.
TaralloMRizzoMIMonarcaC, et al.Optimal care for eyelid contraction after radiotherapy: case report and literature review. J Oral Maxillofac Surg2012; 70: 2459–2465.
9.
Ródenas-HerranzTSánchez-CanoDLinares-GonzalezL,et al.Capecitabine-induced bilateral ectropion on a patient with paraneoplastic dermatomyositis. Dermatol Ther2020; 33: e13772. doi:https://doi.org/10.1111/dth.13772
10.
EsmaeliBHidajiLAdininRB, et al.Blockage of the lacrimal drainage apparatus as a side effect of docetaxel therapy. Cancer2003; 98: 504–507.
MansurCPfeifferMLEsmaeliB. Evaluation and management of chemotherapy-induced epiphora, punctal and canalicular stenosis, and nasolacrimal duct obstruction. Ophthalmic Plast Reconstr Surg2017; 33: 9–12.
13.
DoganSSEsmaeliB. Ocular side effects associated with imatinib mesylate and perifosine for gastrointestinal stromal tumor. Hematol Oncol Clin North Am2009; 23: 109–114.
VinodKDiazV. Use of amniotic membrane graft in the surgical management of cicatricial ectropion associated with cetuximab therapy. J Surg Case Rep2015; 2015: rju143.
TatarSYalçınCESezginB, et al.Capecitabine-Induced bilateral ectropion: a rare ocular manifestation requiring surgical intervention. J Cutan Aesthet Surg2018; 11: 241–244. doi:https://doi.org/10.4103/JCAS.JCAS_5_18
18.
JinHDBlessingNW. Cicatricial ectropion and madarosis associated with panitumumab treatment of metastatic colorectal cancer. Am J Ophthalmol Case Rep2020; 19: 100810. doi:https://doi.org/10.1016/j.ajoc.2020.100810
19.
Saint-JeanASainz de la MazaMMorralM, et al.Ocular adverse events of systemic inhibitors of the epidermal growth factor receptor: report of 5 cases. Ophthalmology2012; 119: 1798–1802.
20.
SuFVirosAMilagreC, et al.Ras mutations in cutaneous squamous-cell carcinomas in patients treated with braf inhibitors. N Engl J Med2012; 366: 207–215.
21.
ZhouLWeiX. Ocular immune-related adverse events associated with immune checkpoint inhibitors in lung cancer. Front Immunol2021; 12: 701951.
22.
ShatzelJJOlsonSRTaoDL, et al.Ibrutinib-associated bleeding: pathogenesis, management and risk reduction strategies. J Thromb Haemost2017; 15: 835–847.
23.
FortesBHTailorPDDalvinLA. Ocular toxicity of targeted anticancer agents. Drugs2021; 81: 771–823.
24.
SayinIAyliMOğuzAK,et al.Xanthelasma palpebrarum: A new side effect of nilotinib. BMJ Case Rep2016 Jan 12; 2016: 10–11.
25.
SivanandamASattarovaVAreauxRG. Dupilumab-associated ectropion and punctal stenosis treated with tacrolimus ointment (0.03%) in a 15-year-old girl. J AAPOS2022; 26: 275–278. doi:https://doi.org/10.1016/j.jaapos.2022.07.002
26.
BarnesACBlandfordADPerryJD. Cicatricial ectropion in a patient treated with dupilumab. Am J Ophthalmol Case Rep2017 Jun 22; 7: 120–122. doi: https://doi.org/10.1016/j.ajoc.2017.06.017. PMID: 29260094; PMCID: PMC5722149.
27.
NettisEGuerrieroSMasciopintoL, et al.Dupilumab-Induced Bilateral Cicatricial Ectropion in real life. J Allergy Clin Immunol Pract2020; 8: 728–729. doi:https://doi.org/10.1016/j.jaip.2019.10.015
28.
LecoufletMVerschooreMGiardC, et al.Myosite orbitaire associée à un traitement par ipilimumab [Orbital myositis associated with ipilimumab]. Ann Dermatol Venereol2013; 140: 448–451. doi:https://doi.org/10.1016/j.annder.2013.02.029
29.
PapavasileiouEPrasadSFreitagSK, et al.Ipilimumab-induced ocular and orbital inflammation–a case series and review of the literature. Ocul Immunol Inflamm2016; 24: 140–146.
30.
ByrdJCFurmanRRCoutreSE, et al.Targeting btk with ibrutinib in relapsed chronic lymphocytic leukemia. N Engl J Med2013; 369: 32–42.
31.
WangMLRuleSMartinP, et al.Targeting btk with ibrutinib in relapsed or refractory mantle-cell lymphoma. N Engl J Med2013; 369: 507–516.
32.
AlberelliMAInnocentiISicaS, et al.Po-54 - clinical and laboratory characterization of platelet dysfunction caused by ibrutinib treatment in patients with chronic lymphocytic leukemia. Thromb Res2016; 140: S196.
33.
LipskyAHFarooquiMZTianX, et al.Incidence and risk factors of bleeding-related adverse events in patients with chronic lymphocytic leukemia treated with ibrutinib. Haematologica2015; 100: 1571–1578.
34.
Abdel-RazeqHSaadehSSMalhisR, et al.Treatment of anemia in cancer patients undergoing chemotherapy aith intravenous ferric carboxymaltose without erythropoiesis-stimulating agents. Ther Adv Med Oncol2020; 12: 1758835920953292.
35.
KnightKWadeSBalducciL. Prevalence and outcomes of anemia in cancer: a systematic review of the literature. Am J Med2004; 116: 11s–26s.
36.
TasFEralpYBasaranM, et al.Anemia in oncology practice: relation to diseases and their therapies. Am J Clin Oncol2002; 25: 371–379.
37.
WeberRSJabbourNMartinRC. 2nd. Anemia and transfusions in patients undergoing surgery for cancer. Ann Surg Oncol2008; 15: 34–45.
38.
BorstlapWAStellingwerfMEMoollaZ, et al.Iron therapy for the treatment of preoperative anaemia in patients with colorectal carcinoma: a systematic review. Colorectal Dis2015; 17: 1044–1054.
39.
CaroJJSalasMWardA,et al.Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review. Cancer2001; 91: 2214–2221.
40.
PlougMKroijerRQvistN,et al.Preoperative intravenous iron treatment in colorectal cancer: experience from clinical practice. J Surg Res2022; 277: 37–43.
41.
GoubranHAElemaryMRadosevichM, et al.Impact of transfusion on cancer growth and outcome. Cancer Growth Metastasis2016; 9: 1–8.
42.
SchullerDEScottCWilsonKM, et al.The effect of perioperative blood transfusion on survival in head and neck cancer. Arch Otolaryngol Head Neck Surg1994; 120: 711–716.
43.
SzakmanyTDoddMDempseyGA, et al.The influence of allogenic blood transfusion in patients having free-flap primary surgery for oral and oropharyngeal squamous cell carcinoma. Br J Cancer2006; 94: 647–653.
44.
VamvakasECBlajchmanMA. Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction?Blood2001; 97: 1180–1195.
45.
LynchKTHassingerTE. Preoperative identification and management of anemia in the colorectal surgery patient. Clin Colon Rectal Surg2023; 36: 161–166.
46.
DeptułaMZielińskiJWardowskaA,et al.Wound healing complications in oncological patients: perspectives for cellular therapy. Postepy Dermatol Alergol2019; 36: 139–146.
47.
GeersNCZegelMHuybregtsJGJ,et al.The influence of preoperative interventions on postoperative surgical wound healing in patients without risk factors: a systematic review. Aesthetic Surg J2018; 38: 1237–1249.
48.
KarakidaKAokiTOtaY, et al.Analysis of risk factors for surgical-site infections in 276 oral cancer surgeries with microvascular free-flap reconstructions at a single university hospital. J Infect Chemother2010; 16: 334–339.
49.
Tavares-JúniorMCMCabreraGEDTeixeiraWGJ, et al.Risk factors associated with postoperative infection in cancer patients undergoing spine surgery. Clinics (Sao Paulo)2021; 76: e2741.
OgiharaHTakeuchiKMajimaY. Risk factors of postoperative infection in head and neck surgery. Auris Nasus Larynx2009; 36: 457–460.
52.
ZirkMLentzenMPBrostE, et al.Surgical side infections of the tracheostomy - a retrospective cohort study of patients with head and neck cancer in intensive care. J Craniomaxillofac Surg2022; 50: 811–816.
53.
GyorkiDEYuanJMuZ, et al.Surgery for patients receiving ipilimumab: safety profile and immunological insights. J Clin Oncol2012; 30: 8583–8583.
54.
WojtukiewiczMZRekMMKarpowiczK, et al.Inhibitors of immune checkpoints-pd-1, pd-l1, ctla-4-new opportunities for cancer patients and a new challenge for internists and general practitioners. Cancer Metastasis Rev2021; 40: 949–982.
55.
AckermanRSMunceyARAldawoodiNN, et al.Cancer immunotherapies: what the perioperative physician needs to know. Curr Oncol Rep2022; 24: 399–414.
56.
EliasAWKasiPMStaufferJA, et al.The feasibility and safety of surgery in patients receiving immune checkpoint inhibitors: a retrospective study. Front Oncol2017; 7: 121.
57.
KwonMJungHNamGH,et al.The right timing, right combination, right sequence, and right delivery for cancer immunotherapy. J Control Release2021; 331: 321–334.
58.
MellorJDCassumbhoyMJeffordM. Clinical guidance on the perioperative use of targeted agents in solid tumor oncology. Asia Pac J Clin Oncol2011; 7: 106–113.
59.
CoutinhoIMarquesMAlmeidaR, et al.Extraocular muscles involvement as the initial presentation in metastatic breast cancer. J Breast Cancer2018; 21: 339–342.
60.
DormandELBanwellPEGoodacreTE. Radiotherapy and wound healing. Int Wound J2005; 2: 112–127.
61.
Framarino-Dei-MalatestaMChiaritoABianciardiF, et al.Metastases to extraocular muscles from breast cancer: case report and up-to-date review of the literature. BMC Cancer2019; 19: 36.
62.
HaubnerFOhmannEPohlF, et al.Wound healing after radiation therapy: review of the literature. Radiat Oncol2012; 7: 162.
63.
DevaliaHLMansfieldL. Radiotherapy and wound healing. Int Wound J2008; 5: 40–44.
64.
DurkinSRRoosDHiggsB, et al.Ophthalmic and adnexal complications of radiotherapy. Acta Ophthalmol Scand2007; 85: 240–250.
65.
NuzziRTrossarelloMBartonciniS, et al.Ocular complications after radiation therapy: an observational study. Clin Ophthalmol2020; 14: 3153–3166.
66.
ChughRBishtYSNautiyalV,et al.Factors influencing the severity of acute radiation-induced skin and mucosal toxicity in head and neck cancer. Cureus2021; 13: e18147.
67.
MulhollandSBoydJBMcCabeS, et al.Recipient vessels in head and neck microsurgery: radiation effect and vessel access. Plast Reconstr Surg1993; 92: 628–632.
68.
HalleMBodinITornvallP, et al.Timing of radiotherapy in head and neck free flap reconstruction–a study of postoperative complications. J Plast Reconstr Aesthet Surg2009; 62: 889–895.
69.
SunKTanJYThomsonPJ,et al.Influence of time between surgery and adjuvant radiotherapy on prognosis for patients with head and neck squamous cell carcinoma: a systematic review. Head Neck2023; 45: 2108–2119.
70.
FijuthJMazeronJ-JLe PéchouxC, et al.Second head and neck cancers following radiation therapy of t1 and t2 cancers of the oral cavity and oropharynx. International Journal of Radiation Oncology*Biology*Physics1992; 24: 59–64.
71.
KourinouKMMazonakisMLyrarakiE, et al.Scattered dose to radiosensitive organs and associated risk for cancer development from head and neck radiotherapy in pediatric patients. Phys Med2013; 29: 650–655.
72.
GregersenPAFundingMAlsnerJ, et al.Genetic testing in adult survivors of retinoblastoma in Denmark: a study of the experience and impact of genetic testing many years after initial diagnosis. Eur J Med Genet2022; 65: 104569.
73.
JanicABowdenSLevyS, et al.Patient-reported outcome measures for retinoblastoma: a scoping review. J Patient Rep Outcomes2020; 4: 66.
74.
TravisLBHillDADoresGM, et al.Breast cancer following radiotherapy and chemotherapy among young women with hodgkin disease. Jama2003; 290: 465–475.
75.
TravisLBRabkinCSBrownLM, et al.Cancer survivorship—genetic susceptibility and second primary cancers: research strategies and recommendations. JNCI: Journal of the National Cancer Institute2006; 98: 15–25.
76.
ObiEESaundersDBurnsJ,et al.Orbital cancer: a second cancer in exenterated patients. Orbit2017; 36: 476–477.
77.
KaspertsNSlotmanBLeemansCR,et al.A review on re-irradiation for recurrent and second primary head and neck cancer. Oral Oncol2005; 41: 225–243.
78.
KreinbrinkPJLewisLMRedmondKP,et al.Reirradiation of recurrent and second primary cancers of the head and neck: a review of the contemporary evidence. Curr Treat Options Oncol2022; 23: 295–310.
79.
WongSJHeronDEStensonK, et al.Locoregional recurrent or second primary head and neck cancer: management strategies and challenges. Am Soc Clin Oncol Educ Book2016; 35: e284–e292.
80.
DionisiFFioricaFD'AngeloE, et al.Organs at risk's tolerance and dose limits for head and neck cancer re-irradiation: a literature review. Oral Oncol2019; 98: 35–47.
81.
FutranNDTrottiAGwedeC. Pentoxifylline in the treatment of radiation-related soft tissue injury: preliminary observations. Laryngoscope1997; 107: 391–395.
82.
SahaiSK. Perioperative assessment of the cancer patient. Best Pract Res Clin Anaesthesiol2013; 27: 465–480.
83.
SahaiSKZalpourARoznerMA. Preoperative evaluation of the oncology patient. Heart Fail Clin2011; 7: 413–426.
84.
LeeBHanHS. Tackling surgical morbidity and mortality through modifiable risk factors in cancer patients. Nutrients2022; 14(15): 3107.
85.
Leide da Silva NunesFCalado Ferreira Pinheiro GadelhaPDamasceno de Souza CostaM, et al.Nutritional status and its impact on time and relocation in postoperative complications of abdominal patients undergoing surgery. Nutr Hosp2014; 30: 629–635.
86.
van StijnMFKorkic-HalilovicIBakkerMS, et al.Preoperative nutrition status and postoperative outcome in elderly general surgery patients: a systematic review. JPEN J Parenter Enteral Nutr2013; 37: 37–43.
87.
MazakiTEbisawaK. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature. J Gastrointest Surg2008; 12: 739–755.
88.
ArendsJBachmannPBaracosV, et al.Espen guidelines on nutrition in cancer patients. Clin Nutr2017; 36: 11–48.
89.
SrinivasaSKahokehrAAYuTC,et al.Preoperative glucocorticoid use in major abdominal surgery: systematic review and meta-analysis of randomized trials. Ann Surg2011; 254: 183–191.
90.
LeeLPatelTCostaA, et al.Screening for frailty in primary care: accuracy of gait speed and hand-grip strength. Can Fam Physician2017; 63: e51–e57.
91.
MinnellaEMAwasthiRLoiselleSE, et al.Effect of exercise and nutrition prehabilitation on functional capacity in esophagogastric cancer surgery: a randomized clinical trial. JAMA Surg2018; 153: 1081–1089.
92.
PanayiACOrkabyARSakthivelD, et al.Impact of frailty on outcomes in surgical patients: a systematic review and meta-analysis. Am J Surg2019; 218: 393–400.
93.
HughesMJHackneyRJLambPJ, et al.Prehabilitation before major abdominal surgery: a systematic review and meta-analysis. World J Surg2019; 43: 1661–1668.
94.
PerryRHerbertGAtkinsonC, et al.Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis. BMJ Open2021; 11: e050806.
95.
ShakyaPPoudelS. Prehabilitation in patients before major surgery: a review article. JNMA J Nepal Med Assoc2022; 60: 909–915.
96.
HidalgoDABaranskiJSinnoS. Aesthetic surgery in patients with lung cancer: a paradigm shift. Plast Reconstr Surg Glob Open2016; 4: e1086.
97.
McDanielJCBrowningKK. Smoking, chronic wound healing, and implications for evidence-based practice. J Wound Ostomy Continence Nurs2014; 41: 415–423.
98.
SilversteinP. Smoking and wound healing. Am J Med1992; 93: 22s–24 s.
99.
ProiettiISkrozaNMambrinA, et al.Aesthetic treatments in cancer patients. Clin Cosmet Investig Dermatol2021; 14: 1831–1837.
100.
BonannoAEsmaeliBFingeretMC, et al.Social challenges of cancer patients with orbitofacial disfigurement. Ophthalmic Plast Reconstr Surg2010; 26: 18–22. doi:https://doi.org/10.1097/IOP.0b013e3181b8e646
101.
KassotisASGrimesJSamieFH, et al.Risk factors for developing depressive symptoms in the immediate postoperative period after mohs micrographic surgery. Orbit2023 Feb; 43(1): 22–27.
102.
ZhangJMillerCJO'MalleyV, et al.Patient quality of life fluctuates before and after mohs micrographic surgery: a longitudinal assessment of the patient experience. J Am Acad Dermatol2018; 78: 1060–1067.
103.
BalakrishnanNAgrawalSBhargavaR, et al.Psychosocial factors among patients undergoing orbital exenteration. Clin Exp Optom2023; 106(6): 626–632.
