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Surgical stress and tumor behavior: Impact of ischemia‐reperfusion and hepatic resection on tumor progression

In this issue of Liver Transplantation, the article from the University of Hong Kong by Man et al. introduces potentially important concepts related to the mechanisms involved in tumor progression associated to surgical stress, specifically hepatic ischemia-reperfusion and major hepatic resection. This study attempted to determine the molecular mechanisms involved in enhanced tumor progression exhibited in the remnant liver following ischemia-reperfusion and major hepatic resection. To study the effects of ischemia-reperfusion and major hepatic resection, the expression of mitogenic/cell cycle–associated molecules (Rho-associated coil-containing protein kinase [ROCK], Cdc42, proliferating cell nuclear antigen [PCNA]), adhesion-associated molecule (FAK), and angiogenic factors (early growth response-1 [Egr-1]/ VEGF) in tumor tissues and cells were evaluated. The data generated on the expression of these markers have provided evidence which indicates that hepatic surgical stress, such as ischemia-reperfusion and major hepatic resection, stimulate tumor cell invasion, migration, and metastasis. However, it is clear that further studies are needed to address the precise significance of the expression of these molecules in relation to tumor progression. The mechanisms of tumor progression are complex. Therefore, the results of the experiments reported in this study must be regarded as preliminary. Nevertheless, the findings in this study may help to elucidate the mechanisms involved and the nature of tumor progression; and, in addition, the findings suggest future therapeutic approaches.