Redefining surgical oncology: active immune microenvironment modulation beyond tumor resection

Area of Science:

• Oncology
• Immunology
• Surgical Science

Background:

• Surgical resection is a cornerstone of solid tumor treatment.
• Surgery induces significant changes in the tumor immune microenvironment (TME).
• Perioperative stress can suppress antitumor immunity and promote disease recurrence.

Purpose of the Study:

• To review evidence on how surgery and systemic stress impact the TME.
• To identify perioperative vulnerabilities and therapeutic targets.
• To explore strategies for optimizing surgical outcomes through immune modulation.

Main Methods:

• Comprehensive literature review of mechanistic and translational studies (PubMed, Web of Science through October 2025).
• Analysis of how surgical injury and stress responses alter immune and stromal cells.
• Identification of intraoperative and systemic interventions.

Main Results:

• Surgical stress can transiently impair anti-tumor immunity, favoring disease persistence.
• Key vulnerabilities include anesthetic choices, stress responses, and inflammatory signaling.
• Actionable entry points include localized drug delivery, immune cell reprogramming, and targeted systemic therapies.

Conclusions:

• Surgery represents a critical "immunologic window" that can be modulated.
• Perioperative interventions can potentially reduce recurrence risk and enhance long-term survival.
• Future research should focus on biomarker-driven trials and high-resolution immune monitoring.