Immunomodulatory effects of total intravenous and balanced inhalation anesthesia in patients with bladder cancer undergoing elective radical Cystectomy: preliminary results

Abstract

BackgroundAlthough surgery and anesthesia induce immunesuppression, remains largely unknown whether various anesthetic techniques have different immunosuppressive effects on cancer patients. Therefore, the aim of this study was to investigate the influence of total intravenous anesthesia with target-controlled infusion (TIVA-TCI) and balanced inhalation anesthesia (BAL) on the peri-operative levels of inflammatory cytokines and regulatory T cells (Tregs) in patients with bladder cancer undergoing surgery.MethodsTwenty eight consecutive patients with bladder cancer who underwent radical cystectomy were prospectively randomized into two groups to receive TIVA-TCI (n = 14) or BAL (n = 14). Before the induction of anesthesia (T0), 6–8 hours (T1) post-surgery, and 5 days post-surgery (T2), Tregs and serum levels of interleukin -1beta (IL-1β), interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukin −2 (IL-2), interleukin −6 (IL-6), and interleukin −10 (IL-10) were measured.ResultsIn the peri-operative period all cancer patients showed a marked and significant increase in IL-6. Moreover, TIVA-TCI patients also showed a higher increase in IFN-γ, whereas in BAL patients Tregs were reduced by approximately 30% during surgery. The incidence of infections, metastases, and death was similar in both groups.ConclusionsThe increase in the Th1 response in the TIVA-TCI group and the reduction in Tregs in the BAL group seem to balance the immunosuppressive effect induced by IL-6. Therefore TIVA-TCI and BAL can be both used in major surgery in patients with bladder cancer without worsening the outcome.

The influence of total intravenous anaesthesia and isoflurane anaesthesia on plasma interleukin-6 and interleukin-10 concentrations after colorectal surgery for cancer

“…22,27,28 The volatile anaesthetics isoflurane and sevoflurane modify tumour cell growth in a time-dependent manner. 29 Similar results to ours have been reported by other studies in both cancer [23][24][25] and noncancer patients. 16,30 Kvarnströ m et al 23 found no significant differences between TIVA with propofol-remifentanil and sevoflurane-fentanyl anaesthesia in IL-6 concentrations during the first 24 h after open colorectal surgery, although potential differences between fentanyl and remifentanil were not considered by the authors.…”

“…16,30 Kvarnströ m et al 23 found no significant differences between TIVA with propofol-remifentanil and sevoflurane-fentanyl anaesthesia in IL-6 concentrations during the first 24 h after open colorectal surgery, although potential differences between fentanyl and remifentanil were not considered by the authors. In patients with bladder cancer undergoing radical cystectomy, Sofra et al 24 reported that the plasma concentration of IL-6 was not significantly influenced in the early postoperative period by anaesthetic management (TIVA vs. sevoflurane). Deegan et al 25 found the same after breast cancer surgery when comparing sevoflurane-fentanyl with propofol-paravertebral anaesthesia.…”

“…2,17,21,22 Only a few studies have focused on the influence of different techniques of general anaesthesia on the interleukin response in cancer patients and the results are not conclusive. [23][24][25] The aim of the present study was to compare the influence of total intravenous anaesthesia (TIVA) using propofol with isoflurane anaesthesia on plasma concentrations of pro-and anti-inflammatory interleukins IL-6 and IL-10 in patients undergoing colorectal surgery for cancer.…”

Comparing the Effects of Combined General/Epidural Anaesthesia and General Anaesthesia on Serum Cytokine Levels in Radical Cystectomy

“…Fakat intraoperatif narkotik analjezik tüketim-lerinin düşük olması, kısa hastane kalış süreleri açısından kombine GEA + HKEA majör cerrahilerde üstünlük sağladığını düşünmek-teyiz. Anahtar Sözcükler: Radikal sistektomi, sitokin, immün fonksiyon, epidural anestezi Öz / Abstract manda cerrahi stres ve genel anestezinin oluşturduğu immün supresyonla zaten immün modülasyonu bozulmuş bu hasta grubunda kanser hücre yayılımı ve erken metastazların oluşum sıklığı artmaktadır (2). Tümör hücre proliferasyonu ve invazyonu spesifik sitokinlerin salınımı ile korelasyon göste-rir.…”

Anaesthesia for oncological surgery – can it really influence cancer recurrence?

“…A retrospective analysis of breast, colon and rectal cancer surgery found an improved one-and five-year overall survival of 4.7% and 5.6%, respectively, with total intravenous anaesthesia compared with sevoflurane anaesthesia [26], and preliminary data from an ongoing prospective randomised controlled trial for radical cystectomy supports these findings by demonstrating improved immune function with total intravenous anaesthesia, namely enhanced cell-mediated immunity [27].…”