Neoadjuvant immunochemotherapy does not increase major surgical complications in oral cavity cancer.

Neoadjuvant immunochemotherapy (NICT) is an emerging strategy for locally advanced oral squamous cell carcinoma (OSCC), yet its impact on perioperative safety remains a significant concern. This study compared major surgical complication rates between patients receiving NICT followed by surgery and those undergoing upfront surgery (US). A retrospective, propensity score-matched cohort study was conducted at a tertiary center. Adults with locally advanced OSCC undergoing curative-intent resection (2016-2024) were included. The NICT group received ≥2 cycles of immune checkpoint inhibitors plus chemotherapy before surgery; the US group proceeded directly to surgery. The primary outcome was the incidence of Clavien-Dindo grade ≥Ⅲ complications within 30 days. After 1:1 matching, 166 pairs were analyzed. The incidence of major complications was 10.2% in the NICT group and 8.4% in the US group (odds ratio [OR] 1.24, 95% confidence interval [CI] 0.59-2.58; p = 0.6). Multivariable analysis confirmed no significant association between NICT and increased complication risk (adjusted OR 1.30, 95% CI 0.61-2.78; p = 0.5). Rates of specific surgical and medical morbidities, 30-day readmission, and hospital length of stay were comparable between groups. Subgroup and sensitivity analyses were consistent with the primary finding. In patients with locally advanced OSCC, NICT was not associated with a statistically significant increase in major postoperative complications compared to upfront surgery. These findings support the surgical safety of NICT and may facilitate its integration into multimodal treatment paradigms.