"Don't let it to air": A cautionary tale of the potential consequences of surgery of residual cancer.

In this issue of the BBI, Haldar et al. demonstrate that major surgical stress from laparotomy caused a significant increase in post-operative metastatic burden in a mouse model of cancer. They identified this metastatic outbreak was driven by a novel mechanism of direct, surgery-induced activation of the primary tumour which, if left in situ, released pro-metastatic factors (IL-6, IL-8, and VEGF). Surgical stress induced significant changes in the transcriptional programming of the primary tumor, with marked activation of NF-κB and down-regulation of IRF-1. Pharmaceutical blockade of post-operative β-adrenergic and prostanoid signalling, by administration of propranolol and etodolac, prevented post-operative activation of the primary tumour and metastatic disease.