Cancer recurrence is multifactorial and determined by patient-, tumour-, and surgery-related factors. Any combination of several mechanisms have been proposed by which cancer may recur following potentially curative resection (Coffey JC, Wang JH, Smith MJF, Bouchier-Hayes D, Cotter TG,and Redmond HP. Excisional surgery for cancer cure: therapy at a cost. Lancet Oncol 2003;4:760-68). Surgery may contribute to the overall residual tumor burden by adding disseminated cancer cells during tumor manipulation. Due to post-operative immunosuppression the patient may become more susceptible to tumorigenesis and/or disseminated cancer cells may escape the immune response more easily. Finally, surgical resection may alter biological properties of cancer cells and lead to increased cellular proliferation and reduced cell death.