Surgery is a mainstay treatment for patients with solid tumours. However, despite surgical resection with a curative intent and numerous advances in the effectiveness of (neo)adjuvant therapies, metastatic disease remains common and carries a high risk of mortality. The biological perturbations that accompany the surgical stress response and the pharmacological effects of anaesthetic drugs, paradoxically, might also promote disease recurrence or the progression of metastatic disease. When cancer cells persist after surgery, either locally or at undiagnosed distant sites, neuroendocrine, immune, and metabolic pathways activated in response to surgery and/or anaesthesia might promote their survival and proliferation. A consequence of this effect is that minimal residual disease might then escape equilibrium and progress to metastatic disease. Herein, we discuss the most promising proposals for the refinement of perioperative care that might address these challenges. We outline the rationale and early evidence for the adaptation of anaesthetic techniques and the strategic use of anti-adrenergic, anti-inflammatory, and/or antithrombotic therapies. Many of these strategies are currently under evaluation in large-cohort trials and hold promise as affordable, readily available interventions that will improve the postoperative recurrence-free survival of patients with cancer.

外科手术是实体瘤患者的主要治疗手段。然而，尽管具有治愈意图的外科手术切除和（新）辅助疗法的有效性取得了许多进展，但是转移性疾病仍然很常见并且具有很高的死亡风险。自相矛盾的是，伴随手术压力反应的生物扰动和麻醉药的药理作用也可能促进疾病的复发或转移性疾病的发展。当癌细胞在手术后持续存在时，无论是局部还是未诊断的远处，响应手术和/或麻醉而激活的神经内分泌，免疫和代谢途径都可能促进其存活和增殖。这种影响的结果是，最小的残留疾病可能会随后逃脱平衡并发展为转移性疾病。在此处，我们讨论了改善围手术期护理的最有希望的建议，这些建议可能会解决这些挑战。我们概述了麻醉技术的适应性以及抗肾上腺素能，抗炎药和/或抗血栓形成疗法的策略性应用的基本原理和早期证据。目前，这些策略中的许多策略正在大型队列研究中进行评估，并有望作为负担得起，易于获得的干预措施，以改善癌症患者的术后无复发生存率。