Figure 1.

Effects of tumor removal on promotion of metastases. These effects include accelerated growth of micrometastases and establishment of new metastatic foci. Surgery increases tumor cell dissemination, increased circulating tumor cells’ survival by enhancing immune evasion, enhanced entrapment at metastatic site and increased invasion and migration capabilities to establish new metastatic foci. Surgery can also induce changes in the environment of micrometastatic disease to enhance its growth. Multiple therapeutic approaches illustrated in this diagram can be considered to target the protumorigenic inflammatory changes in the perioperative period.