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Abstract
Surgery is the main radical method of therapy for most cancers. However, there is accumulating evidence of postsurgery immunodeficiency, which probably is a main factor in tumor progression. On the other hand, cancer patients may initially have a certain immune imbalance due to the tumour process. The transition of dormant tumor cells into a proliferative state promotes recurrence and metastasis in a short time after surgery. Such a burden on immunocompromised cancer patients after surgery can be associated with severe surgical trauma, which is especially typical for locally advanced cancer. Systemic response to tissue damage after surgery and wound surface formation provoke a cascade of disorders in the cellular immune system. The main event in this process is the release of high concentrations of circulating damage-associated molecular patterns (DAMPs), which provokes activation of the local and systemic inflammatory response. Studies have shown an association of inflammatory markers in the early postoperative period with outcomes in solid tumors. Neutrophils mediate the primary response to surgical trauma, and the formation of neutrophil extracellular traps (NETs) promotes tumor progression. Activated macrophages during wound healing represent a tumor-associated phenotype that promotes tumor progression. In addition, recruitment and activation of myeloid-derived suppressor cells (MDSCs), regulatory T lymphocytes (Tregs), increased expression of programmed cell death ligand-1 (PD-L1) on immune cells, vascular endothelial growth factor (VEGF) during surgical trauma exacerbate immunosuppression and contribute to the formation of a pre-metastatic niche. Therapeutic strategies to normalize cellular immunity after surgery include anti-DAMPs, reduction of postoperative inflammation, immunotherapy combined with surgery, anti-angiogenic and targeted therapy against neutrophils, macrophages, MDSCs and Tregs. In addition, various surgical techniques can be used for this purpose to promote favourable and early healing of the postoperative wound, including an adequately performed reconstruction, which also affects postsurgical immunity. In general, modern methods of treatment aimed at activating cellular immunity in the postoperative period require the development of new integrated approaches. There is a need for an in-depth study of the basic mechanisms of immune dysfunction associated with surgical trauma, the course of the postoperative wound process, phenotyping of immunosuppressive cells and the development of modern, personalized methods for the prevention and treatment of such conditions.
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