Biomarkers in Onco-anaesthesia: A Narrative Review

Onco-anaesthesia has evolved into a distinct subspecialty that addresses the complex physiological derangements associated with malignancy, anticancer therapies and major oncological surgery. Conventional perioperative risk assessment tools often fail to capture the cumulative burden of tumour biology, systemic inflammation, organ dysfunction, malnutrition and frailty in cancer patients. Biomarkers, as objectively measurable indicators of biological and pathological processes, offer a promising adjunct for refined perioperative risk stratification and personalised care. This narrative review comprises of current evidence on biomarkers relevant to onco-anaesthesia and onco-critical care, encompassing acute-phase reactants, inflammatory and immune markers, cardiac biomarkers, organ-specific injury indicators, stress–pain–frailty biomarkers and nutritional indices. Their biological rationale, clinical utility, limitations and emerging roles within enhanced recovery after surgery pathways are discussed. We highlight the potential of biomarker-guided perioperative strategies to predict complications, guide optimisation and improve outcomes. Future integration of validated biomarkers with clinical assessment and precision-based perioperative pathways may significantly enhance individualised care for patients undergoing cancer surgery.