Surgical intervention strategies for tumor microenvironment (TME) associated therapeutic resistance

The tumor microenvironment (TME) drives therapeutic resistance through immunosuppression, stromal remodeling, and metabolic reprogramming, which pose a major challenge in solid tumor treatment. While surgery remains a cornerstone for tumor eradication, perioperative inflammatory responses and ischemia-reperfusion injuries may exacerbate TME deterioration. However, surgery also offers a strategic opportunity for TME modulation. This narrative review analyzes TME components and resistance mechanisms, proposing a multi-stage intervention framework: preoperative TME reshaping, intraoperative precision resection with local therapy, and postoperative dynamic monitoring. We further explore a multidisciplinary whole-course management model, integrating cutting-edge technologies such as radiomics and single-cell sequencing. By bridging basic research with clinical translation, this review aims to guide surgeons in transitioning from tumor resection to TME precision regulation, with a focus on perioperative multi-stage interventions.