While myeloid-derived suppressor cells (MDSCs) have been reported to participate in the promotion of angiogenesis and tumor growth, little is known about their presence and function during perioperative period. Here, we demonstrated that human MDSCs expressing CD11b 1 , CD33 1 and HLA-DR -significantly increased in lung cancer patients after thoracotomy. CD11b 1 CD33 1 HLA-DR -MDSCs isolated 24 hr after surgery from lung cancer patients were more efficient in promoting angiogenesis and tumor growth than MDSCs isolated before surgical operation in allograft tumor model. In addition, CD11b 1 CD33 1 HLA-DR -MDSCs produced high levels of MMP-9. Using an experimental lung metastasis mouse model, we demonstrated that the numbers of metastases on lung surface and Gr-1 1 CD11b 1 MDSCs at postoperative period were enhanced in proportion to the degree of surgical manipulation. We also examined that syngeneic bone marrow mesenchymal stem cells (BMSCs) significantly inhibited the induction and proliferation of Gr-1 1 CD11b 1 MDSCs and further prevented lung metastasis formation in the mice undergoing laparotomy. Taken together, our results suggest that postoperatively induced MDSCs were qualified with potent proangiogenic and tumor-promotive ability and this cell population should be considered as a target for preventing postoperative tumor metastasis.Surgery excision of primary tumor is a mainstay of therapy in many tumor types, but emerging experimental and clinical evidence suggests that surgical intervention may promote the spreading and seeding of malignant cells and the growth of preexisting micrometastasis in some cancers. 1 Surgeryinduced stress can modify the neural, endocrine, inflammatory, metabolic and immunologic microenvironment of malignant cells. 2 Following a major surgery, cellular immunity remains suppressed for several days with decrease in circulating levels of cytotoxic T lymphocytes (CTLs), natural killer (NK) cells, dendritic cells (DCs) and T-helper cells. 2 The magnitude of this immune suppression is proportional to the degree of surgical manipulation. 3 Therefore, the immediate postoperative period may contribute substantially to the risk of subsequent emergence of metastasis, and perioperative modulations that reduce this risk may improve long-term outcome. 3,4 While the potential for surgical operation to attenuate antitumor cell-mediated immune response is well recognized, very few studies have been conducted to investigate immunosuppressive aspects in perioperative context.Myeloid-derived suppressor cells (MDSCs), a definition that reflects both their origin and function, represent a heterogeneous population of myeloid cells that inhibit antitumor immune response. 5 In humans, MDSCs are characterized by the cell surface expression of integrin CD11b, sialic acidbinding lectin CD33 and low expression of the MHC Class II molecule-HLA-DR. 6 The expression of CD14 and nuclear