The effects of epidural anaesthesia and analgesia on T lymphocytes differentiation markers and cytokines in patients after gastric cancer resection

Abstract

Background Epidural use can prevent peri-operative neuro-endocrine stress responses, mitigate pain after surgery, and reduce opioid use, which all lead to immunosuppression. Methods Forty patients with gastric cancer were ultimately enrolled into the study. Patients who received general anaesthesia (GA group, n = 20) or a combination of general anaesthesia and peri-operative epidural use (EGA group, n = 20) were given intravenous analgesia or epidural analgesia, respectively. We collected visual analogue scale (VAS) scores, length of hospital stay, the time of the first passage of flatus and incidence of postoperative nausea and vomiting (PONV). We also collected data on the cluster of differentiation markers (CD) 3+ , CD 4+ , CD 8+ , CD 4+ /CD 8+ , interleukin (IL)-4, IL-6, and interferon (IFN)-γ the day before surgery as well as on postoperative days 1, 3, and 7. Results VAS scores and PONV in the GA group were higher than in the EGA group on postoperative day 3. CD 3+ , CD 4+ , and CD 4+ /CD 8+ T cells declined on postoperative day 3 and nearly recovered to baseline seven days after surgery in both groups. CD 3+ T cells decreased more in the GA group than in the EGA group. IL-4, IL-6, and IFN-γ increased on postoperative day 3 and nearly recovered to baseline seven days after surgery in both groups. IL-4 and IL-6 increased more in the GA group than in the EGA group. IFN-γ increased more in the EGA group than in the GA group. Conclusions A combination of general anaesthesia and peri-operative epidural use can relieve postoperative pain and PONV. A combination of general anaesthesia and peri-operative epidural use decreases immunosuppression in gastric cancer resection. Trial registration The study procedures were approved by the Ethics Committee of The Harbin Medical University Cancer Hospital. This study was registered prospectively at http://www.chictr.org.cn/index.aspx on October 10, 2017 (Registered ChiCTR-INR-17012939 ).

Antitumor Anesthetic Strategy in the Perioperatory Period of the Oncological Patient: A Review

“…These results are explained because epidural anesthesia allows to preserve a greater number and activity of NK cells during the perioperative period, offering certain antitumor properties in its clinical application in oncological surgery (65). Randomized controlled trials comparing regional techniques with general anesthesia in patients with cancer reported a significant reduction in NK-cell and T-cell activity compared with patients who received general anesthesia alone (94,95). Thus, regional anesthesia could be considered as a potential technique to reduce surgical stress response, improve pain control, and reduce postoperative complications (67), proposing oncological benefits.…”

Anaesthesia as an influence in tumour progression

“…Similar results are shown in gastric cancer. Epidural anaesthesia preserves CD3+ cells, limits the release of IL-4 and IL-6 and increases the release of interferon (INF)-γ [ 55 ]. Two RCTs evaluate the effect of an epidural anaesthesia in combination with a TIVA for oesophagectomy vs. TIVA and intravenous opioids.…”

“…Two RCTs evaluate the effect of an epidural anaesthesia in combination with a TIVA for oesophagectomy vs. TIVA and intravenous opioids. Both revealed a reduced stress response with the use of an epidural anaesthesia [ 55 , 56 ]. In detail, a reduction of IL-6, norepinephrine, cortisol, and adrenocorticotropic hormone (ACTH) was shown in combination with a higher secretion of IL-10, 3 h after surgery [ 57 ].…”

The outcome of intravenous and inhalation anesthesia after pancreatic cancer resection: a retrospective study

“…In addition, surgical trauma and the use of anesthetic drugs in the perioperative period can inhibit the body's anti-tumor immunity [ 4 ]. The effect of different anesthetic drugs on tumor cells and cancer patients has always been a research hotspot [ 5 , 6 ].…”