Surgical Resection and Remodeling of the Tumor Microenvironment in Colorectal Cancer

Surgery is an important treatment for solid tumors at present, but surgical removal of tumors also causes a series of complex biological changes. Surgical trauma can trigger a systemic inflammatory response, accompanied by functional alterations in natural killer cells, monocytes and other immune cells, as well as the release of damage-associated molecular patterns (DAMPs). For example, the high mobility group box-1 protein (HMGB1) could affect the inflammatory response and the tumor microenvironment through the Toll-like receptor (TLR)-related signaling pathway. At the same time, the activation of cancer-associated fibroblasts (CAFs) and the remodeling of extracellular matrix (ECM) during wound healing can further change the structure of tumor tissue, which may further affect the subsequent tumor cells' survival and the development of peri-metastatic lesions. In addition to the resection itself, the choice of anesthetic agent for surgery, perioperative stress response and continued changes may affect the tumor microenvironment and human immunity and may interact with surgery-induced inflammation and immunosuppression. Therefore, surgery should not be regarded as a simple tumor resection, but as a complex biological event that can simultaneously reshape the immune status of the body and the local tumor microenvironment. An in-depth understanding of the interplay between surgical trauma, immune regulation, tissue remodeling, and anesthesia in colorectal cancer will help to further understand the perioperative tumor biology and provide a theoretical basis for potential perioperative intervention strategies.