Deleterious synergistic effects of distress and surgery on cancer metastasis: Abolishment through an integrated perioperative immune-stimulating stress-inflammatory-reducing intervention.

•Perioperative interventions to improve long-term cancer outcomes are rarely used.•Pre-operative psychological stress exacerbates the deleterious effects of surgery.•Pre-operative psychological stress jeopardizes the efficacy of immune stimulation.•Immune-stimulation combined with blockade of stress & surgery’s effects is optimal.