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General anesthesia combined with epidural anesthesia ameliorates the effect of fast-track surgery by mitigating immunosuppression and facilitating intestinal functional recovery in colon cancer patients

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to investigate the influence of anesthetic methods on markers of anti-tumor immunity and intestinal functions in fast-track surgery in colon cancer (CC) patients during the perioperative period.

Patients and methods

A total of 53 patients with American Society of Anesthesiologists (ASA) I-II status randomly received general anesthesia (G group, n = 27) or general anesthesia combined with epidural anesthesia (E group, n = 26) for surgical tumor resection. The recovery times of intestinal function were evaluated in both groups postoperatively. The frequencies of different subsets of CD4+ T cells and myeloid-derived suppressor cells and C-reactive protein (CRP) were measured by flow cytometry and enzyme-linked immunosorbent assay, respectively, before anesthesia (t0), 1 h after the beginning of surgery (t1), 1 h after the end of surgery (t2), and on day 2 (t3) and day 5 (t4) post-surgery.

Results

There was no significant difference in demographic characteristics between the two groups, but the E group of patients received significantly lower amounts of morphine and sevoflurane. In comparison with those in the G group, significantly greater numbers of lymphocytes and elevated frequencies of Th1 cells were detected at t3 and t4 post-surgery in the E group (p < 0.01). Significantly lower percentages of Th2 cells and regulatory T cells were detected in the E group at t2–4 post-surgery. Whereas the levels of plasma CRP increased post-surgery in both groups, the levels of CRP were significantly lower in the E group than those in the G group at t3–4 post-surgery (p < 0.05). The times to the first flatus and to tolerate a full diet were significantly shorter in the E group than those in the G group (p < 0.01).

Conclusion

General anesthesia combined with epidural anesthesia plays an important role in fast-track surgery, mitigating the surgical stress-related impairment of anti-tumor immune responses and hastening the recovery of intestinal function. This combination might also help to improve long-term outcomes for CC patients.

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Funding

This research is sponsored by Program of Shanghai Subject Chief Scientist (2012-2014, 12XD1401900). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

The authors have declared that no competing interests exist.

Author information

Authors and Affiliations

  1. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Li Ren, Ye Wei, De-Xiang Zhu & Jian-Min Xu

  2. Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China

    Wan-Kun Chen & Chang-Hong Miao

  3. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China

    Wan-Kun Chen & Chang-Hong Miao

Authors
  1. Wan-Kun Chen
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  2. Li Ren
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  3. Ye Wei
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  4. De-Xiang Zhu
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  5. Chang-Hong Miao
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  6. Jian-Min Xu
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Corresponding authors

Correspondence to Chang-Hong Miao or Jian-Min Xu.

Additional information

Wan-Kun Chen, Li Ren, Ye Wei, and De-Xiang Zhu contributed to this work equally and should be considered as first co-authors.

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Chen, WK., Ren, L., Wei, Y. et al. General anesthesia combined with epidural anesthesia ameliorates the effect of fast-track surgery by mitigating immunosuppression and facilitating intestinal functional recovery in colon cancer patients. Int J Colorectal Dis 30, 475–481 (2015). https://doi.org/10.1007/s00384-014-2098-1

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  • DOI: https://doi.org/10.1007/s00384-014-2098-1

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