原发肿瘤的手术切除是实体恶性肿瘤最常见和最有效的治疗方法。令人信服的证据表明，尽管手术具有有益效果，但它可能会通过引发免疫抑制性炎症应激反应来损害免疫监视，并通过刺激微小残留病而促进复发。此外，许多因素会在癌症手术前后干扰免疫效应器，例如营养不良、贫血或随后的输血。因此，围手术期在决定肿瘤结果方面发挥着关键作用，并且是通过使用协同药理学和非药理学方法支持免疫系统来规避麻醉和手术有害因素的短期阶段。与此相一致的是，越来越多的研究表明麻醉剂可以在癌症手术期间或之后驱动促肿瘤或抗肿瘤信号通路。虽然专注于麻醉剂对癌细胞行为影响的临床前研究非常有说服力，但研究其对生存和复发的影响的有限临床试验仍然没有结论。在此，我们重点介绍癌症手术围手术期发生的主要因素及其对免疫调节和癌症进展的潜在影响。我们还考虑了文献中的最新进展，讨论手术前和手术期间的患者管理。

Surgical excision of the primary tumor represents the most frequent and curative procedure for solid malignancies. Compelling evidence suggests that, despite its beneficial effects, surgery may impair immunosurveillance by triggering an immunosuppressive inflammatory stress response and favor recurrence by stimulating minimal residual disease. In addition, many factors interfere with the immune effectors before and after cancer procedures, such as malnutrition, anemia, or subsequent transfusion. Thus, the perioperative period plays a key role in determining oncological outcomes and represents a short phase to circumvent anesthetic and surgical deleterious factors by supporting the immune system through the use of synergistic pharmacological and non-pharmacological approaches. In line with this, accumulating studies indicate that anesthetic agents could drive both protumor or antitumor signaling pathways during or after cancer surgery. While preclinical investigations focusing on anesthetics' impact on the behavior of cancer cells are quite convincing, limited clinical trials studying the consequences on survival and recurrences remain inconclusive. Herein, we highlight the main factors occurring during the perioperative period of cancer surgery and their potential impact on immunomodulation and cancer progression. We also discuss patient management prior to and during surgery, taking into consideration the latest advances in the literature.