Core Viewpoint - The article discusses the significant role of preoperative exercise in preventing colorectal cancer liver metastasis (CRLM) by enhancing anti-tumor immune responses through Kupffer cells [3][6]. Group 1: Colorectal Cancer and Liver Metastasis - Colorectal cancer (CRC) is the third most common cancer globally and the second leading cause of cancer-related deaths, with approximately 50% of patients developing liver metastasis [2]. - Surgical resection of liver metastases can improve overall survival rates by 15% to 20%, but 50% to 60% of patients experience recurrence due to undetected micro-metastases or tumor cell dissemination [2][5]. Group 2: Impact of Surgical Stress - Surgical-induced immune dysregulation alters the host-tumor immune environment, potentially promoting tumor recurrence [2]. - Postoperative systemic and local inflammation is directly associated with poorer cancer prognosis, although the mechanisms remain poorly understood [2]. Group 3: Research Findings - A study published by Zhang Hongji's team indicates that preoperative exercise (PEx) for four weeks can induce anti-tumor Kupffer cells, limiting tumor growth in a mouse model of surgical stress-promoted liver metastasis [3][6]. - Preoperative exercise enhances the release of cytotoxic cytokines from Kupffer cells and increases the recruitment and activation of CD8+ T cells via the CXCL9-CXCR3 signaling axis [5][6]. - Elevated levels of CXCL9 were observed in the serum of both mice and patients post-exercise, with Kupffer cells identified as the primary source [5][6]. Group 4: Implications of the Study - The study suggests that preoperative exercise could serve as a non-invasive strategy to reduce cancer metastasis and recurrence rates, providing potential targets for exercise mimetic therapies [8].