Is surgical trauma prometastatic?

A review of the literature is made on animal models showing that surgical trauma can facilitate the metastatic spread of experimental tumours. Whilst clinical evidence is often lacking, except controversial results for blood transfusion, several rodent models provided proof that operative stress, peritoneal trauma and hepatectomy create conditions which facilitate cancer metastasis. Moreover, it seems that mechanisms through which the metastatic process can be enhanced include inflammation, angiogenesis, secretion of growth factors and immunosuppression. Animal models do have limitations and the clinical translation is difficult. However, these models suggest that molecular mediators induced by surgical trauma can enhance metastasis. These molecules, already identified in surgical patients, could be inhibited with already available drugs. Appropriate controlled clinical studies covering the perioperative period should be designed.