This narrative review explores the surgical stress response and its modulation by anesthesia. The human body responds to surgical trauma through neurohormonal and immunological changes, aiming to restore homeostasis. However, this response can lead to systemic inflammatory response syndrome (SIRS), characterized by hypermetabolism and hypercatabolism. The review discusses preoperative measures, anesthetic drugs, and techniques that can reduce the stress response and improve patient recovery. The surgical stress response involves the sympatho-adrenomedullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axes. The SAM axis is activated by surgical trauma, leading to increased sympathetic activity, vasoconstriction, and elevated cortisol levels. The HPA axis also plays a role, with cortisol levels rising postoperatively and remaining elevated for up to seven days after major surgery. These hormonal changes influence the immune system, contributing to inflammation and potentially affecting cancer recurrence. The review highlights the impact of anesthetic drugs and techniques on the surgical stress response. Preoperative measures such as beta-blockers, avoidance of prolonged fasting, and immune-modulating nutrition can reduce the burden of surgical trauma. Anesthetic drugs like propofol and volatile agents have different effects on the stress response and immune system. Propofol has anti-inflammatory and immunosuppressive properties, while volatile agents may have negative effects on cancer progression. Regional anesthesia techniques, such as epidural and spinal anesthesia, can reduce the stress response by inhibiting the HPA axis and decreasing sympathetic activity. These techniques also offer benefits in reducing postoperative complications and improving recovery. However, the effectiveness of these techniques in reducing cancer recurrence remains unclear. The review emphasizes the importance of multimodal analgesia, early mobilization, and early enteral nutrition in reducing the stress response and improving patient outcomes. It also discusses the role of immunomodulatory nutrition in postoperative recovery and the need for further research to clarify the effects of various anesthetic techniques on the surgical stress response and cancer outcomes. Overall, the review concludes that proper preoperative measures, adequate anesthesia, and multimodal strategies can help reduce the stress response and improve surgical outcomes.This narrative review explores the surgical stress response and its modulation by anesthesia. The human body responds to surgical trauma through neurohormonal and immunological changes, aiming to restore homeostasis. However, this response can lead to systemic inflammatory response syndrome (SIRS), characterized by hypermetabolism and hypercatabolism. The review discusses preoperative measures, anesthetic drugs, and techniques that can reduce the stress response and improve patient recovery. The surgical stress response involves the sympatho-adrenomedullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axes. The SAM axis is activated by surgical trauma, leading to increased sympathetic activity, vasoconstriction, and elevated cortisol levels. The HPA axis also plays a role, with cortisol levels rising postoperatively and remaining elevated for up to seven days after major surgery. These hormonal changes influence the immune system, contributing to inflammation and potentially affecting cancer recurrence. The review highlights the impact of anesthetic drugs and techniques on the surgical stress response. Preoperative measures such as beta-blockers, avoidance of prolonged fasting, and immune-modulating nutrition can reduce the burden of surgical trauma. Anesthetic drugs like propofol and volatile agents have different effects on the stress response and immune system. Propofol has anti-inflammatory and immunosuppressive properties, while volatile agents may have negative effects on cancer progression. Regional anesthesia techniques, such as epidural and spinal anesthesia, can reduce the stress response by inhibiting the HPA axis and decreasing sympathetic activity. These techniques also offer benefits in reducing postoperative complications and improving recovery. However, the effectiveness of these techniques in reducing cancer recurrence remains unclear. The review emphasizes the importance of multimodal analgesia, early mobilization, and early enteral nutrition in reducing the stress response and improving patient outcomes. It also discusses the role of immunomodulatory nutrition in postoperative recovery and the need for further research to clarify the effects of various anesthetic techniques on the surgical stress response and cancer outcomes. Overall, the review concludes that proper preoperative measures, adequate anesthesia, and multimodal strategies can help reduce the stress response and improve surgical outcomes.