Resposta endócrino metabólica e imunológica ao trauma cirúrgico: mecanismos fisiopatológicos, repercussões clínicas e estratégias de modulação

Surgical trauma triggers a complex systemic response characterized by the interaction of neuroendocrine mechanisms, alterations in energy metabolism, and immunoinflammatory activation. Although initially adaptive, this response may contribute to insulin resistance, hyperglycemia, protein catabolism, endothelial dysfunction, and postoperative complications when its intensity or duration exceeds the body's regulatory capacity. The objective of this study was to synthesize scientific evidence published over the past ten years on the endocrine-metabolic and immune responses to surgical trauma, highlighting their underlying mechanisms, clinical implications, and potential for perioperative modulation. A targeted literature search was conducted in PubMed and ScienceDirect, considering publications from 2016 to 2026. Narrative reviews, systematic reviews, meta-analyses, and clinical studies relevant to the research question were prioritized. The findings were organized into thematic categories. The literature indicates that activation of the hypothalamic-pituitary-adrenal axis and the sympathoadrenal system induces hormonal changes that promote energy mobilization and hepatic glucose production. Concurrently, inflammatory mediators contribute to insulin resistance, immune modulation, and catabolism. The magnitude of this response depends on the extent of tissue injury, individual patient characteristics, anesthetic technique, pain management, and nutritional care. Multimodal recovery strategies may attenuate certain components of this response, although the magnitude of their benefits varies across surgical procedures and patient populations. It is concluded that the response to surgical trauma should be understood as an integrated neuroendocrine, metabolic, and immune network whose individualized modulation may contribute to postoperative recovery. However, challenges remain in establishing standardized biomarkers and determining which interventions are most effective for specific patient profiles.