Journal: Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
This publication is a clinical review focused on perioperative immune‑related adverse events (irAEs) in gastric cancer patients treated with immune checkpoint inhibitors, especially in the neoadjuvant setting.
Key points:
- Clinical problem: Perioperative irAEs often mimic common postoperative complications in both timing and presentation, creating high risk for misdiagnosis, delayed recognition, or inappropriate management.
- High‑risk irAEs discussed:
- • ICI‑related pneumonitis
- • Hypophysitis
- • Adrenal insufficiency
- • Hypothyroidism
- Symptom‑oriented framework: The article organizes discussion around typical perioperative issues—fatigue, hypotension, electrolyte imbalance, altered mental status, postoperative fever, hypoxemia, dyspnea, cough, and enzyme abnormalities—and contrasts likely irAEs with surgical complications such as infection, bleeding, pulmonary events, myocardial infarction, and procedure‑related pancreatic injury.
- Diagnostic approach:
- • Emphasizes practical bedside clues to differentiate irAEs from surgical causes.
- • Stresses the need to actively consider irAEs when standard postoperative explanations are inadequate or when symptoms are atypical in course or severity.
- Management principles:
- • Early involvement of relevant specialists (endocrinology, pulmonology, critical care) is advised when irAEs are suspected.
- • Prompt initiation of immunosuppression—particularly corticosteroids—is highlighted as crucial to limit morbidity and reduce mortality, while also avoiding unnecessary antibiotics, re‑operations, or other overtreatment for presumed surgical complications.
- Perioperative systems of care:
- • Advocates for standardized, multidisciplinary perioperative pathways in the context of neoadjuvant immunotherapy.
- • Recommends comprehensive preoperative baseline assessment of cardiac, pulmonary, hepatic, and endocrine function.
- • Supports protocolized postoperative monitoring at defined time points and risk‑stratified response plans.
Overall, the article positions structured recognition and management of perioperative irAEs as essential to maintaining surgical safety while preserving the benefits of immunotherapy in gastric cancer.