Effect of different anaesthesia methods on perioperative cellular immune function and long-term outcome in patients undergoing radical resection of esophageal cancer: a prospective cohort study

Abstract

To analyze the effects of different anaesthetic methods on perioperative cellular immunity and long-term outcome in patients who undergo esophageal cancer surgery.

Participants: A total of 120 patients with esophageal cancer admitted to Zhengzhou University People's Hospital from January 2016 to January 2017 were recruited and randomly divided into a GA group (general anaesthesia, n = 40), a PG group (paravertebral nerve block with general anaesthesia, n = 40) and an EG group (epidural anaesthesia with general anaesthesia, n = 40).

Methods: Self-rating anxiety scale and visual analogue scale scores were adopted to compare postoperative anxiety and the degree of pain of patients in the three groups. In addition, the adverse reactions of patients in the three groups were compared. The levels of interleukin-6 (IL-6), IL-4, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and the survival of T-cell subsets (CD3+, CD4+, CD8+, CD4+/CD8+) before operation, at the end of operation, and on postoperative day (POD) 1 and POD 2 were measured by either ELISA or flow cytometry.

Results: In the PG and EG group, the VAS scores were lower, and fewer opioids and vasoactive agents were used than in the GA group. In both the EG and PG groups, higher CD3+ and CD4+ cell survival and lower levels of Cor, IL-4, and IL-6 were identified at the end of or after the surgery than in the GA group. Moreover, the postoperative survival curves of the PG and EG groups were better than that of the GA group.

Conclusions: The combination of paravertebral nerve block or epidural anaesthesia and general anaesthesia may improve perioperative immune function and long-term outcome in patients who undergo esophageal cancer surgery.

Keywords: Cellular immunity; cytokinesis; epidural block; esophageal cancer; long-term follow-up; paravertebral block.

Figure 1

Comparison of VAS scores (A), SAS scores (B), Anesthetic and vasoactive drug consumption (C) and postoperative adverse reactions (D) among three groups. *P<0.05: the EG group vs the GA group at the corresponding time point; #P<0.05: the PG group vs the GA group at the corresponding time point; ^P<0.05: the PG group vs the EG group at the corresponding time point. POD-1 = postoperative day 1; POD-2 = postoperative day 2.

Figure 2

The cytokine levels as measured by ELISA in all groups; *P<0.05: the EG group vs the GA group at the corresponding time point; #P<0.05: the PG group vs the GA group at the corresponding time point; POD-1 = postoperative day 1; POD-2 = postoperative day 2.

Figure 3

Comparison of the ratios of (A) CD3+, (B) CD4+, (C) CD8+ lymphocyte subsets and (D) CD4+/CD8+ lymphocytes among the three groups. *P<0.05: the EG group vs. the GA group at the corresponding time point; #P<0.05: the PG group vs. the GA group at the corresponding time point; POD-1 = postoperative day 1; POD-2 = postoperative day 2.

Figure 4

Flow cytometry analyses of T-lymphocyte subsets at different time points among the three groups. A. CD3+ cell levels, CD4+ cell levels, CD8+ cell levels, and CD4+ cell levels/CD8+ cell levels at the time point of before surgery among the three groups; B. CD3+ cell levels, CD4+ cell levels, CD8+ cell levels, and CD4+ cell levels/CD8+ cell levels at the time point of the end of surgery among the three groups; C. CD3+ cell levels, CD4+ cell levels, CD8+ cell levels and CD4+ cell levels/CD8+ cell levels at the time point of POD-1 among the three groups; D. CD3+ cell levels, CD4+ cell levels, CD8+ cell levels and CD4+ cell levels/CD8+ cell levels at the time point of POD-2 among the three groups; POD-1 = postoperative day 1; POD-2 = postoperative day 2.

Figure 5

K-M curves of esophageal cancer patients among the three groups.