Beyond the Knife: The Transformative Integration of Immunotherapy and Targeted Therapies in Surgical Oncology

The integration of surgical oncology with immune therapy and molecularly targeted therapy sees the greatest development in the field of modern medicine. This article reflects the summary of the literature from over 200 clinical studies and trials can be used as benchmarks for the distinct treatment’s procedures throughout the perioperative continuum. The results show that immunotherapy as a neoadjuvant induces pathologic complete responses in 20-30% of solid tumors, whereas intraoperative molecular imaging and localized delivery systems support surgical precision. When the targeted adjuvant drugs are chosen according to circulating tumor DNA, their effectiveness in recurrences decreases by 40-60% in different types of cancers. By critically examining the dynamics of the tumor microenvironment, surgical stress is shown to have both immune suppressive and immune stimulating effects that can be treated with medication. We offer the uniform criteria for assessing pathological and immunological reactions, list specific management of toxicity different from the typical one in surgical patients, and designate the routes for clinical biomarkers based on which treatment is to be administered. The new model of treatment is to include surgery not only as a single item but as a critical part of patient-specific immuno-oncology in the primary goal of having long-term systemic control. Keywords: neoadjuvant immunotherapy, precision surgery, tumor microenvironment, immune checkpoint inhibitors, minimal residual disease, fluorescence-guided resection, molecular targeted therapy, perioperative immunology DOI: 10.7176/JMPB/75-06 Publication date: June 30th 2025