This book highlights that, although surgical removal of primary tumors remains the most effective and potentially curative treatment for solid cancers, surgery itself can impair the body’s natural defenses. Nociceptive stimulation induces a stress response that weakens anticancer immunity, while tumor manipulation may release circulating tumor cells, contributing to metastasis and recurrence. In addition, surgical inflammation promotes cytokine and vascular growth factor production, further supporting oncogenesis.

Thus, despite its undeniable benefits, surgery is inherently immunosuppressive, and many cancer patients already have compromised immune function due to neoadjuvant therapies, anemia, transfusions, or malnutrition. Recent advances underscore the importance of preserving and enhancing immune function to improve postoperative outcomes. However, no current volume comprehensively addresses perioperative immunosuppressive factors or offers practical guidance for clinicians to select protocols that support immune competence during cancer surgery.

The book is structured into five sections: general principles; preoperative, intraoperative, and postoperative management; and future research directions in onco-anesthesiology. Each section provides detailed explanations of immunosuppressive mechanisms and their management, covering both pharmacological and non-pharmacological strategies aimed at strengthening immune effector function, enhancing anticancer responses during surgery, and complementing standard oncologic therapies. It also outlines directions for future research by discussing potential therapeutic approaches in onco-anesthesiology and onco-immunology.

Addressing a critical gap in current literature, this volume offers a comprehensive handbook on perioperative immunodepression and surgical stress—topics often overlooked in existing texts. It provides clinicians with actionable strategies for immune support and researchers with guidance for advancing the field.

Designed for residents and fellows in anesthesia, oncology, immunology, and surgery, as well as practicing clinicians and allied health professionals, this book is an essential resource for anyone involved in cancer care and research.

Dr. Lucillia Bezu is holder of a M.D. in Anesthesiology and Intensive Care and a Ph.D. in Onco-immunology. In 2020, she began studying the immune properties of anesthetic agents and their clinical impact after cancer surgery. Her research found out the signaling pathways by which local anesthetics induce direct anticancer effects, promote an antitumor immune response potentiated by immunotherapy, induce immune memory and abscopal effects (Bezu L et al. JITC 2022, Bezu L et al. Semin Immunopathol 2023). She was awarded at the national French anesthesiology congress (SFAR 2021, France). Her work was also selected among the best abstracts of the American Society of Anesthesiologists meeting (ASA 2021, USA), and she received the Junior Faculty Research Award for Laboratory Science from the American Association of University Anesthesiologists meeting (AUA 2022, USA). Dr Lucillia Bezu is also involved in clinical research, teaching and training. She created the first teaching in onco-anesthesiology at Paris Saclay University (Paris, France) and is the editor of the French books in onco-anesthesiology and onco-intensive care (Edition John Libbey Eurotext, Arnette). She is a committee member of The EuroPeriscope group (European group dedicated to perioperative care in cancer surgery) and the leader of the subforum ‘Cancer’ for the scientific committee of the ESA-IC (European Society of Anesthesiology and Intensive Care). Since 2023, she works as a visiting scholar at Stanford University.