[The effect of propofol and sevoflurane on the perioperative immunity in patients under laparoscopic radical resection of colorectal cancer]

Abstract

Objective: To compare the effect of propofol and sevoflurane on perioperative immunity and surgical outcomes in patients undergoing laparoscopic radical resection of colorectal cancer.

Methods: During September 2012 to April 2014 in Sir Run Run Shaw Hospital, thirty patients scheduled for laparoscopic colorectal cancer radical resection were randomly assigned into two groups: propofol TCI anesthesia and sevoflurane inhale anesthesia. Venous blood was taken before induction, on finishing the surgery and 24 h after surgery for lymphocyte subtype study by flow cytometry. Postoperative outcomes including intestinal obstruction, urine retention, anastomotic fistula and incision healing, antibiotic using time, hospital-stay time were compared.

Results: In the sevoflurane group, the percentage of CD3⁺, CD4⁺ and CD19⁺ subtype were increased immediately after surgery ((64.0 ± 13.5)%, (37.5 ± 11.8)%, (12.3 ± 4.5)%) comparing to preoperative level ((59.0 ± 12.0)%, (33.0 ± 8.3)%, (9.9 ± 4.3)%) (t= 3.423, 2.543, 2.768 respectively, all P<0.05), while NK cell percentage was significantly decreased ((22.9 ± 13.2)% vs (30.7 ± 11.9)%) (t=-3.444, P<0.01). The changes of CD3⁺, CD19⁺ and NK cell remained significant at 24 h ((63.5 ± 9.3)%, (13.0 ± 4.0)%, (22.5 ± 7.2)%) (t=2.961, 3.502, -4.621 respectively, all P<0.05). In the propofol group, the levels of CD3⁺, CD4⁺, CD19⁺ and CD4⁺ /CD8⁺ ratio were significantly increased after surgery ((69.4 ± 9.7)%, (43.2 ± 9.2)%, (15.2 ± 7.4)%, 1.9 ± 0.9) comparing to the preoperative levels ((61.9 ± 13.6)%, (34.6 ± 8.9)%, (10.4 ± 4.5)%, 1.5 ± 0.7) (t= 4.732, 6.132, 3.688, 4.640 respectively, all P<0.01), and NK cell was significantly decreased ((14.7 ± 10.2)% vs (27.2 ± 14.3)%) (t=-4.935, P<0.01). These changes were similar to that of the sevoflurane group. At 24 h in the propofol group, comparing with those after surgery, CD3⁺, CD4⁺ and CD4⁺ /CD8⁺ ratio were significantly decreased ((63.6 ± 12.3)%, (36.0 ± 8.7)%, 1.5 ± 0.6) (t=-2.879, -3.682, -3.340 respectively, all P<0.05), and returned to baseline when comparing to the preoperative level (t= 0.858, 0.758, -0.074 respectively, all P>0.05). NK cell began to recover at 24 h ((22.2 ± 12.6)%) comparing to the postoperative level (t= 2.941, P<0.05), but was still lower than the baseline (t=-2.249, P<0.05). Also, for all the above data, there were no difference between the two groups at any points (all P>0.05). There were no difference in hospital-stay time, antibiotic using time, the time to anal exhaust or defecate, postoperative fever, incision infection, neither other complications such as intestinal obstruction, urine retention, anastomotic fistula or intraperitoneal infection (all P>0.05). The incision infection rate was 0 in the propofol group while 14.3% in the sevoflurane group, which was quite clinically obvious though not statistically significant.

Conclusions: Propofol may have less or shorter impact on immunity. However, whether anesthesia with propofol could be superior to that with sevoflurane for patients' immune function is still undetermined and needs further study.