Effects of surgery, general anesthesia, and perioperative epidural analgesia on the immune function of patients with non-small cell lung cancer

• Published in: Journal of clinical anesthesia 2013-06, Vol.25 (4), p.255-262
• Main Authors: Cata, Juan P., MD, Bauer, Maria, MD, Sokari, Telemate, MD, Ramirez, María F., MD, Mason, David, MD, Plautz, Gregory, MD, Kurz, Andrea, MD
• Format: Article
• Language: English
• Subjects: Aged; Analgesia, epidural; Analgesia, Epidural - methods; Analgesics, Opioid - administration & dosage; Anesthesia; Anesthesia & Perioperative Care; Anesthesia, General - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Consciousness Monitors; Cytokines - blood; Cytotoxicity; Female; Fentanyl - administration & dosage; Flow cytometry; Humans; Immune system; Immunity, Innate; Infections; Innate immunity; Lung cancer; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymphocytes; Male; Medical sciences; Methyl Ethers - administration & dosage; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Natural Killer T-Cells - immunology; Natural killers non-small cell lung cancer; Ostomy; Pain; Pain Medicine; Pain, Postoperative - drug therapy; Pneumology; Postoperative Period; Sevoflurane; Surgery; Tumors; Tumors of the respiratory system and mediastinum; Ventilation
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2012.12.007

Abstract Study Objective To assess preoperative and postoperative immune function in patients undergoing surgical resection of non-small cell lung cancer during general anesthesia and postoperative epidural analgesia. Design Observational single-center study. Setting University-affiliated academic center. Patients 24 adult, ASA physical status 3 and 4 patients with stage 1, 2, or 3 non-small cell lung cancer. No study patient received preoperative chemotherapy or radiation. Interventions Patients underwent t horacotomy with general anesthesia and postoperative epidural analgesia. Measurements Bispectral index monitoring, sevoflurane requirements, and intraoperative transfusions were recorded. Total fentanyl consumption and pain (verbal numeric rating scale) were recorded 24 hours after surgery. Preoperative and 24-hour postoperative natural killer cell percentage and function and percentages of natural killer T cells, T helper cells (CD4 +), and cytotoxic T lymphocytes (CD8 +) were measured. Plasma concentrations of the TH 1 cytokine interleukin-2 and interferon-gamma and the TH 2 cytokines interleukin-4 were measured at the same time points. Results The percentage (preoperative, 13.07 ± 9.81% vs postoperative, 9.6 ± 6.57%, P < 0.001) and function (preoperative, 31.61 ± 21.96%; postoperative, 13.61 ± 9.36%; P < 0.001) of natural killer cells was significantly decreased after surgery, but the percentage of natural killer T cells, T helper cells (CD4 +), and cytotoxic T lymphocytes (CD8 +) remained unchanged postoperatively; thus, the CD4/CD8 ratio remained unchanged. Postoperative plasma concentrations of the three cytokines were similar to preoperative levels; therefore, the TH 1/TH 2 ratio also remained unchanged. Conclusions Innate immunity is depressed in patients with non-small cell lung cancer after surgical resection, and immunity is not preserved by the use of postoperative epidural analgesia.