Postoperative complications in patients with chemotherapy-induced acute myeloid leukemia (Review).

The present comprehensive review examines the latest clinical and translational research on postoperative complications in adult patients with chemotherapy-treated acute myeloid leukemia (AML) undergoing elective and emergency surgery. Patients with chemotherapy-treated AML face a markedly elevated risk of postoperative complications, with nearly one-half of patients experiencing complications such as severe infections and bleeding, with associated postoperative mortality rates of 10-20%. These risks are primarily driven by profound neutropenia and thrombocytopenia, impairing immune defense and hemostasis. A key clinical implication is that meticulous perioperative management can improve outcomes despite immunosuppression. Whenever possible, elective surgeries should be deferred until bone marrow recovery, with neutrophils at >1,000/µl and platelets at >50×109/l. Management requires a multidisciplinary approach, involving hematologists optimizing blood counts with growth factors and transfusions, and infectious disease specialists guiding broad-spectrum antibiotic and antifungal prophylaxis. In urgent surgeries, aggressive supportive measures (colony-stimulating factors, transfusions and antimicrobials) are critical to prevent early infectious complications. Postoperatively, vigilant monitoring and early intervention are essential. This strategy includes intensive care support when indicated, surveillance for subtle signs of infection or bleeding, and the routine implementation of mechanical thromboprophylaxis. By adopting this strategy, teams can mitigate complications and improve outcomes for this high-risk population. Further research and coordinated clinical guidelines are required to refine perioperative strategies and improve outcomes.