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<p>The tumor microenvironment (TME) drives therapeutic resistance through immunosuppression, stromal remodeling, and metabolic reprogramming, which pose a major challenge in solid tumor treatment. While surgery remains a cornerstone for tumor eradication, perioperative inflammatory responses and ischemia-reperfusion injuries may exacerbate TME deterioration. However, surgery also offers a strategic opportunity for TME modulation. This narrative review analyzes TME components and resistance mechanisms, proposing a multi-stage intervention framework: preoperative TME reshaping, intraoperative precision resection with local therapy, and postoperative dynamic monitoring. We further explore a multidisciplinary whole-course management model, integrating cutting-edge technologies such as radiomics and single-cell sequencing. By bridging basic research with clinical translation, this review aims to guide surgeons in transitioning from tumor resection to TME precision regulation, with a focus on perioperative multi-stage interventions.</p>

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Surgical intervention strategies for tumor microenvironment (TME) associated therapeutic resistance

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月4日

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  • Dong Chen,
  • Hanyu Wang,
  • Xu Che

摘要

The tumor microenvironment (TME) drives therapeutic resistance through immunosuppression, stromal remodeling, and metabolic reprogramming, which pose a major challenge in solid tumor treatment. While surgery remains a cornerstone for tumor eradication, perioperative inflammatory responses and ischemia-reperfusion injuries may exacerbate TME deterioration. However, surgery also offers a strategic opportunity for TME modulation. This narrative review analyzes TME components and resistance mechanisms, proposing a multi-stage intervention framework: preoperative TME reshaping, intraoperative precision resection with local therapy, and postoperative dynamic monitoring. We further explore a multidisciplinary whole-course management model, integrating cutting-edge technologies such as radiomics and single-cell sequencing. By bridging basic research with clinical translation, this review aims to guide surgeons in transitioning from tumor resection to TME precision regulation, with a focus on perioperative multi-stage interventions.