Energy-based surgery generated carbonized particles promote the development of ovarian cancer

Cancer patients face a high risk of tumor recurrence and metastasis after surgery. Surgical stress has been reported to be an important trigger for cancer recurrence and metastasis. Energy-based surgical devices have become the most commonly used surgical tool in recent years. However, there is a lack of studies investigating whether using energy-based surgical devices promotes the development of residual tumors. This study aimed to examine the impact of energy-based surgery on tumor growth in comparison to conventional surgery. Results indicated that energy-based surgery is more likely to promote tumor growth than conventional surgery. Further investigation revealed that the carbonized particles produced by energy-based surgical devices during tissue combustion are robust inducers, strongly inducing the polarization of M2-like macrophages in vivo and in vitro. Additionally, carbonized particles induced an immunosuppressive tumor microenvironment in vivo, promoting tumor growth similarly to energy-based surgery. These findings suggested that the production of carbonized particles during energy-based surgery contributed to the development of residual tumor cells. Therefore, it is advisable to implement measures to either eliminate or prevent the production of carbonized particles during energy-based surgery procedures. [Display omitted] •Energy-based surgery promotes peritoneal tumor growth by changing the TME compared to conventional surgery.•Carbonized particles generated by energy-based surgery induce M2 macrophage polarization and release of TGF-β and IL-10.•Carbonized particles promote residual tumor growth; avoiding their production in energy-based surgery is recommended.