Effects of different methods of anesthesia on acute gastrointestinal dysfunction, postoperative cognitive impairment, and the immune status after laparoscopic radical rectal cancer surgery

Abstract

Background With an increase in the aged population in China, the annual incidence of rectal cancer is gradually increasing. This study compares the effects of two anesthesia methods on patients undergoing laparoscopic radical rectal cancer surgery. Method A total of 230 patients who underwent laparoscopic radical resection for rectal cancer in the Department of Anesthesiology, Huai'an First People's Hospital Affiliated to Nanjing Medical University from 2016 to 2021 were retrospectively analyzed. The general data, clinical symptoms, immune cell count, and cytokine count were collected on the first, third, and fifth postoperative days. In addition, the patients' Mini-Mental State Examination (MMSE) score was recorded, and dynamic analysis was performed to record gastrointestinal dysfunction after the operation. Results The postoperative awakening time (18.41 ± 2.88 vs. 23.23 ± 4.34), extubation time (27.84 ± 3.67 vs. 34.32 ± 5.73), and length of hospital stay (9.73 ± 1.32 vs. 12.32 ± 2.34) were shorter, while the postoperative MMSE score (25.43 ± 1.43 vs. 21.32 ± 2.32) was higher in patients administered general anesthesia plus epidural anesthesia than in those administered only general anesthesia. The proportion of CD4 + T lymphocytes was higher (39.45 ± 4.12 vs. 35.45 ± 4.56), and the proportion of CD8 + T lymphocytes was lower (25.34 ± 3.09 vs. 28.43 ± 3.43) in patients undergoing general anesthesia plus epidural anesthesia than in those undergoing only general anesthesia. Moreover, the count of natural killer (NK) cells was lower (0.104 ± 0.021 vs. 0.167 ± 0.024) and the level of human leukocyte antigen–DR isotype (HLA-DR) (66.43 ± 7.43 vs. 56.45 ± 6.43) was higher in patients administered general anesthesia plus epidural anesthesia. In addition, the levels of interleukin (IL)-6, IL-8, and IL-10 decreased with statistical differences (P < 0.05), and the probability of increased intra-abdominal pressure and acute gastrointestinal injury was lower (P < 0.05) in patients undergoing general anesthesia plus epidural anesthesia. Conclusion Addition of epidural anesthesia to general anesthesia can reduce the incidence of postoperative cognitive dysfunction, gastrointestinal injury, immunosuppression, postoperative awakening time, extubation time, and length of postoperative hospital stay.