Effects of propofol and sevoflurane on perioperative immune response in patients undergoing laparoscopic radical hysterectomy for cervical cancer

Abstract

The aim of this study is to compare the effects of propofol and sevoflurane anesthesia on perioperative immune response in patients undergoing laparoscopic radical hysterectomy for cervical cancer.Sixty patients with cervical cancer scheduled for elective laparoscopic radical hysterectomy under general anesthesia were randomized into 2 groups. TIVA group received propofol induction and maintenance and SEVO group received sevoflurane induction and maintenance. Blood samples were collected at 30 min before induction (T0); the end of the operation (T1); and 24 h (T2), 48 h (T3), and 72 h (T4) after operation. The T lymphocyte subsets (including CD3+ cells, CD4+ cells, and CD8+ cells) and CD4+/CD8+ ratio, natural killer (NK) cells, and B lymphocytes were analyzed by flow cytometry.After surgery, all immunological indicators except CD8+ cells were significantly decreased in both groups compared to basal levels in T0, and the counts of CD3+ cells, CD4+ cells, NK cells, and the CD4+/CD8+ ratios were significantly lower in the SEVO groups than that in the TIVA group. However, the numbers of B cells were comparable at all the time points between 2 groups.Laparoscopic radical hysterectomy for cervical cancer is associated with postoperative lymphopenia. In terms of protecting circulating lymphocytes, propofol is superior to sevoflurane.

The Effects of Preoperative Oral Carbohydrate on Frequency of T and NK Cells in Patients with Cervical Cancer Treated Using Neoadjuvant Chemotherapy and Surgery: A Prospective Cohort Study

“…Major surgery can impair cell-mediated immunity in the short term, with decreases in tumor necrosis factor-alpha, interleukin-2, interferon-gamma, and lymphoproliferation [38]. Consistent with our findings, a previous investigation reported that RH for cervical cancer reduced CD4 + T cell and NK cell numbers [16]. It is possible that immune dysfunction after surgical treatment of cervical cancer may impair antitumor immunity.…”

“…Previous studies of patients with cervical cancer have described alterations in T cell and NK cell populations [13], suppression of NK cell activity by CD4 + regulatory T cells [14], and reduced numbers of CD4 + T cells and NK cells in the neoplastic cervix [15]. Importantly, RH for cervical cancer has been reported to decrease CD4 + T cell and NK cell numbers and the CD4 + /CD8 + ratio [16], indicating that surgery can cause immune dysregulation. Although NAC for cervical cancer appears not to suppress lymphocyte numbers, lower levels of CD4 + T cells, CD8 + T cells, and NK cells are associated with a poorer response to chemotherapy [17,18].…”

An assessment of the survival impact of multimodal anesthesia/analgesia technique in adults undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a propensity score matched analysis

“…Unlike our study population where patients received propofol in combination with other anesthetics including dexmedetomidine, ketamine, lidocaine, celecoxib, pregabalin and tramadol, patients in the studies by Wigmore et al, and Wu et al received a predominantly propofol-based TIVA without any of the oral and IV adjuncts administered in our MA group. Unlike propofol which has mainly been associated with properties which may reduce the survival of tumors [17][18][19], some of the components of MA in our study namely, dexmedetomidine and ketamine, have been associated with some pro-tumoral effects [20][21][22][23]. For example, dexmedetomidine has been shown to increase tumor cell retention and promote metastasis in rodent models of breast, lung and colon cancers [21].…”

<p>Anesthetic Strategies in Oncological Surgery: Not Only a Simple Sleep, but Also Impact on Immunosuppression and Cancer Recurrence</p>

“…56 Another further prospective study compared the effects of propofol and sevoflurane anesthesia with respect to perioperative immune response in 58 patients undergoing laparoscopic radical hysterectomy for cervical cancer. 57 Compared to volatile-based anesthesia, a propofol-based anesthesiologic strategy was characterized by a lower immunosuppression during the perioperative period; however, no differences in short-term adverse consequence, such as hospital stay and infection rate, were reported between groups. 57 A recent systematic review suggests that total intravenous anesthesia might reduce the overall mortality and improve the recurrence-free survival.…”