The Affect Of Propofol And Sevoflurane On The Perioperative Immunity In Patients Under Laparo-scopic Radical Resection Of Colorectal Cancer

Background:Perioperative immunosuppression caused by surgery and anesthesia could contribute to cancer recurrence and metastasis, thus affect the long-term outcome. Comparing to open surgery, laparoscopic colorectal cancer surgery has the advantage of minimal incision and invasion, rapid recovery, fewer complications, shorter hospital-stay, higher quality of life after surgery, as well as reduced stress reaction caused by operation. However, tumor recurrence and metastasis remain the leading cause of patients’ death. And as an important part of perioperation, the affect of anesthetics and anesthesia technique on the immune system has attracted public attention. Anesthesiologists are bound to seek for appropriate anesthesia technique that can best reserve immune function, and decrease the risk of recurrence and metastasis. Subject:By comparing the affect of propofol and sevoflurane on the perioperative immunity and surgical outcomes in patients undergoing laparoscopic radical resection of colorectal cancer, try to find out anesthetics which preserve perioperative immunity better and thus reduce recurrence and metastasis.Methods:Thirty (30) patients undergoing laparoscopic colorectal cancer radical resection were randomly assigned into two groups:group T and I. After induced with propofol, sufentanil and cisatracurium, anesthesia were maintained either with propofol and remifentanil in group T, or with sevoflurane and remifentanil in group I. Venous blood was taken before induction, on finishing the surgery and24h after surgery for immunological study, such as lymphocyte subtype by flow cytometry and Thl, Th2lymphocyte identification by PCR. Postoperative outcomes including infection, intestinal obstruction, urine retention, anastomotic fistula and incision healing, hospital-stay time were compared.Results:28patients out of the30finished this study. In group I, the levels of CD3+, CD4+and CD19+were increased immediately after surgery (64.03±13.47,37.54±11.83and12.30±4.48) comparing to preoperative level (58.97±11.98,33.00±8.26and9.93±4.35)(P<0.05), while NK cell percentage was significantly decreased(22.92±13.23vs30.68±11.90)(P<0.01); The changes of CD3+,CD4+and NK cell remained significant at24h (63.47±9.26,35.57±6.97and22.5±7.23)(P<0.05or0.01). Th2lymphocytes were slightly increased at the end of surgery (P>0.05). In group T, the levels of CD3+、CD4+、CD19+, and CD4+/CD8+ratio were significantly increased after surgery(69.41±9.69,43.20±9.25,15.15±7.39, and1.93±0.91) comparing to the preoperative levels (61.88±13.63,34.59±8.90,10.35±4.52, and1.47±0.73)(P<0.01), and NK cell was significantly decreased (P<0.01). These changes were similar to that of group I. At24h in group T, comparing with those after surgery, CD3+,CD4+, and CD4+/CD8+ratio were significantly decreased(63.61±12.33,35.96±8.73, and1.46±0.60)(P<0.05or P<0.01), and returned to baseline. NK cell began to recover at24h (22.15±12.55) comparing to the postoperative level (P<0.05) but was still lower than the base line (P<0.05). CD19+remained increased at24h (P<0.01). There were no difference of CD8+or Thl lymphocyte among these three time points (P>0.05). Also, for all the above data, there were no difference between the two groups at any points (P>0.05). There were no difference in infection rate, intestinal obstruction, urine retention, anastomotic fistula and hospital-stay time as well.Conclusions:We observed that the level of peripheral lymphocyte increased transiently after operation and then presented to decrease24h after surgery. The result was not consistent with many previous studies. It may not stand for an enhanced immunologic function but could be the result of lymphocyte redistribution. Improved perioperative technique such as laparoscopic surgery, fast-track clinical pass way, intraoperative heat preservation and so on may result in milder patient stress response and out weight the choice of anesthetics. NK cell was significantly lower after surgery in both groups, and it started to return to baseline earlier within24h in group T, but not in the group I. It may indicate that propofol had a shorter affect on immune cells than sevoflurane had. However, whether anesthesia with propofol could be superior to that with sevoflurane for patients’ immune function is still undetermined and needs further study.