Effects Of Sevofluran-based Inhalation Anesthetics Vs. Propofol-based Intravenous Anesthetics And Transfusion On The Immune Function For Pancreatic Cancer Patients

Part 1. Allogeneic blood transfusion for the clinical outcomes in patients undergoing colorectal cancer surgeryObjectiveTo evaluate the effects of allogeneic blood transfusion (ABT) on long term prognosis in patients with colorectal cancer undergoing surgery.MethodsPubMed^ EMbase, The Cochrane Library and CBM were searched for collecting studies on the correlation between ABT and clinical outcomes of colorectal cancer, and relevant articles were also retrieved from inception to march,2014. Two reviewers independently screened the literature, extracted the data and evaluated the quality, Then the meta-analysis was performed by using Statal2.0 software.Results8 studies involving 5479 patients were finally included. The results of meta-analysis showed that:Compared with non-transfusion group, the risks of overall survival and disease-specific survival in transfusion group were increased by 21%(HR= 1.21; 95% CI, 1.09-1.33;p<0.001) and 47%(HR=1.47; 95% CI,1.17-1.84;p=0.001), respectively, the difference was statistically significant; whereas there was no difference between 2 groups in the risks of disease free survival, local recurrence and distant metastasis.ConclusionsIn patients with CRC undergoing surgery, ABTs are associated with adverse clinical outcomes, including increased risks of overall survival and disease-specific survival. Therefore, it is of great clinical significance to take active perioperative blood conservation strategies to decrease ABT rate.Part 2. Effects of volatile vs. propofol-based intravenous anesthetics on the alveolar inflammatory responses to one-lung ventilationObjectiveThe aim of this meta-analysis is to compare the potential effects of inhalation anesthetics with total intravenous anesthetics on alveolar cytokine expression and lung-related clinical outcomes in patients undergoing one-lung ventilation (OLV) for thoracic surgery.MethodsWe retrieved the PubMed, EMBASE and the Cochrane Library respectively to identify randomized controlled trials comparing different anesthetics (volatile anesthetics vs. intravenous anesthetics) on the pulmonary inflammatory response to OLV. The primary outcomes were the levels of alveolar concentrations of inflammatory cytokines.ResultsEight randomized controlled trials that included 365 patients were screened. Overall, there were significant differences in the concentration of alveolar inflammatory mediators between volatile group and intravenous group, in which volatile group had lower levels of TNF-a (SMD,-1.51; 95% CI,-2.15--0.87; P< 0.001), IL-6 (SMD,-0.70; 95% CI,-0.99--0.41; P< 0.001) and IL-8 (SMD,-1.32; 95% CI,-2.20--0.45; P= 0.003). The overall number of pulmonary complications in the volatile group was smaller (RR,0.42; 95% CI, 0.23-0.77; P= 0.005) and patients in that group had significantly abridged nospitalization stay (WMD,-3.59 days; 95% CI,-5.70--1.48 days; P= 0.001).ConclusionsInhalation anesthetics might be preferable in patients undergoing OLV for thoracic surgery and their protective effects might work via attenuating inflammatory responses.Part 3. Effects of volatile vs. propofol-based intravenous anesthetics and transfusion on the immune function for pancreatic cancer patientsObjectiveThe aim of this study was to investigate the influence of 2 established anesthetic techniques:total propofol-based intravenous anesthesia and sevofluran-based inhalation anesthesia and transfusion on the perioperative induced changes of peripheral blood mononuclear cells (PBMCs), changes in lymphocyte subsets, and the balance of pro-inflammatory and cytokines for pancreatic cancer patients.MethodsFor the pancreatic cancer patients which pancreaticoduodenectomy were performed from December 2013 to July 2014 in one medical centre, prospective, randomized controlled trial was carried out. The enrolled pancreatic cancer patients were randomly divided into propofol group (P group) and sevofluran group (S group) using random number table. Changes in differential counts, lymphocyte subsets, were determined before surgery and in the early postoperative period, the postoperative period complications were also determined. Plasma concentrations of pro-inflammatory cytokines (IL-1β, IL-6, IL-8 and TNF-a) were measured before, during, and after surgery.ResultsThis study involved 60 pancreatic cancer patients with American Society of Anesthesiologists (ASA) physical status I-III who randomized prospectively into one of two groups(propofol group and sevofluran group), each group has 30 patients. Propofol group has eleven patients received blood transfusion during operation, sevofluran group has ten patients received blood transfusion during operation. Compared to S group, plasma concentration of CD4+, CD8+ and CD16+ CD56+ was lower in P group at T1(P< 0.05), plasma concentration of CD8+ was lower in P group at T2(P< 0.05) and plasma concentration of IL-6, IL-8 was higher in P group at T1 and T2(P< 0.05) for patients not received transfusion. Compared to S group, plasma concentration of CD4+, CD8+ and CD16+ 6+ was lower in P group at T1(P<0.05), plasma concentration of CD8+ and CD16+ 6T was lower in P group at T2(P< 0.05), plasma concentration of IL-6, IL-8 was higher in P group at T1(P< 0.05) and plasma concentration of IL-6 wans higher at T2(P<0.05) for patients received transfusion. Compared to non-transfusion group, plasma concentration of CD4+, CD8+ and CD16+CD56+was lower at T1(P< 0.05) and plasma concentration of CD8+ T and IL-8 was higher(P< 0.05) in transfusion group.But for postoperative period complications, the two group did not show significant difference.ConclusionsSevofluran-based inhalation anesthetics might be preferable in patients undergoing pancreaticoduodenectomy for pancreatic cancer patients. Moreover, blood transfusion might have a big influence on T lymphocyte subsets. But for postoperative period complications, the two group did not show significant difference.