Surgical excision of the primary tumor represents the most frequent and curative procedure for solid malignancies. Compelling evidence suggests that, despite its beneficial effects, surgery may impair immunosurveillance by triggering an immunosuppressive inflammatory stress response and favor recurrence by stimulating minimal residual disease. In addition, many factors interfere with the immune effectors before and after cancer procedures, such as malnutrition, anemia, or subsequent transfusion. Thus, the perioperative period plays a key role in determining oncological outcomes and represents a short phase to circumvent anesthetic and surgical deleterious factors by supporting the immune system through the use of synergistic pharmacological and non-pharmacological approaches. In line with this, accumulating studies indicate that anesthetic agents could drive both protumor or antitumor signaling pathways during or after cancer surgery. While preclinical investigations focusing on anesthetics’ impact on the behavior of cancer cells are quite convincing, limited clinical trials studying the consequences on survival and recurrences remain inconclusive. Herein, we highlight the main factors occurring during the perioperative period of cancer surgery and their potential impact on immunomodulation and cancer progression. We also discuss patient management prior to and during surgery, taking into consideration the latest advances in the literature.
原发性肿瘤的手术切除是实体恶性肿瘤最常见且具有治愈性的治疗手段。有充分证据表明，尽管手术具有治疗效果，但可能通过引发免疫抑制性炎症应激反应而削弱免疫监视功能，并通过刺激微小残留病灶促进肿瘤复发。此外，在癌症治疗前后存在多种因素干扰免疫效应，如营养不良、贫血或后续输血等。因此，围手术期在决定肿瘤预后方面起着关键作用，这一阶段为通过协同药物与非药物手段支持免疫系统、规避麻醉与手术相关有害因素提供了重要窗口期。与此相应，越来越多的研究表明麻醉药物在癌症手术期间或术后可能同时驱动促肿瘤或抗肿瘤信号通路。尽管临床前研究关于麻醉剂对癌细胞行为影响的结论颇具说服力，但探讨其对生存率和复发影响的临床试验仍有限且结论尚未明确。本文重点阐述癌症手术围术期的主要影响因素及其对免疫调节和癌症进展的潜在作用，同时结合文献最新进展探讨术前及术中的患者管理策略。
Perioperative Immunosuppressive Factors during Cancer Surgery: An Updated Review
肿瘤(癌症)患者之家