DOI: https://doi.org/10.22141/2224-0586.1.96.2019.158748

The changes in lymphocyte populations in patients with colorectal cancer depending on the method of anesthesia during surgical treatment

Y.A. Gorkavyi, I.I. Lisnyy

Abstract


Background. In the perioperative period, stress response induced by surgery together with some anesthetics and analgesics can cause immunosuppression. That can be accompanied by a decrease in the number of lymphocyte populations and their activity, thus forming an immunosuppressive state. Recent retrospective studies and meta-analyzes show that mitigation of surgical stress can reduce cancer mortality and cancer recurrence due to reduced immunosuppression after the surgical treatment of colon cancer, therefore the choice of method of perioperative analgesia in colorectal surgery with minimal effect on the immune system remains relevant. The purpose of the study was to study the effect of various methods of perioperative analgesia on some indicators of the immune system and level of immunosuppression through quantitative changes in lymphocyte populations and T-lymphocyte activity during surgical treatment of colorectal cancer. Materials and methods. The study included 60 patients operated for colorectal cancer. The patients were randomized into two groups with diagnosed colorectal cancer (T2-3N0-2M0). The control points for the studying the number of CD3+, CD4+, CD8+, CD3-CD56+/CD16+, CD4/CD8 were: the first point — before the operation, the second point — in three days after the operation, the point 3 — in 7–10 days after the operation, the point four — 3 months after the operation. Results. The study found the patients after inhalation anesthetic sevorane to be used for general anesthesia to have reduced T-lymphocyte activity and a minimal effect on the number of all lymphocyte populations studied in the early postoperative period. The administration of propofol for gene­ral anesthesia less influenced on the activity of T-lymphocytes in comparison with sevorane administration in the early postoperative period. Patients with epidural analgesia for periope­rative analgesia had long-lasting positive effect on the immune system in the late postoperative period, which was accompanied by the restoration and increasing of T-lymphocyte activity at the late postoperative period in comparison with parenteral opioid analgesia after surgery. Propofol and epidural analgesia had a minimal effect on the quantitative lymphocyte population in comparison with sevorane in the studied groups. The parenteral opioid analgesic omnopon for postoperative analgesia caused a significant decrease in T-lymphocyte activity, which was observed in the late postoperative period compared with the group with epidural analgesia. Conclusions. The use of epidural analgesia in combination with parenteral dexketoprofen and paracetamol for perioperative analgesia had a lower immunosuppressive effect in comparison with parenteral opioid omnopon and is more preferable for analgesia in patients with colorectal cancer. Propofol save T-lymphocyte activity compared with inhaled anesthetic sevorane and may be preferable as a hypnotic for general anesthesia in patients during surgical treatment of colorectal cancer.


Keywords


rectal cancer; epidural analgesia; propofol; se­vorane; lymphocyte populations; T-lymphocyte activity

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