title: Effects of surgery, general anesthesia, and perioperative epidural analgesia on the immune function of patients with non-small cell lung cancer.
abstract: 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.
  
  
  METHODS
  Observational single-center study.
  
  
  METHODS
  University-affiliated academic center.
  
  
  METHODS
  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.
  
  
  METHODS
  Patients underwent thoracotomy with general anesthesia and postoperative epidural analgesia.
  
  
  METHODS
  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 TH1 cytokine interleukin-2 and interferon-gamma and the TH2 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 TH1/TH2 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.
authors: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. jcata@mdanderson.org
authors: Juan P
authors: JP
authors: Cata
authors: Maria
authors: M
authors: Bauer
authors: Telemate
authors: T
authors: Sokari
authors: María F
authors: MF
authors: Ramirez
authors: David
authors: D
authors: Mason
authors: Gregory
authors: G
authors: Plautz
authors: Andrea
authors: A
authors: Kurz
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D056805:Consciousness Monitors; D016207:Cytokines / Q000097:blood; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007113:Immunity, Innate; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D055611:Natural Killer T-Cells / Q000276:immunology; D010149:Postoperative Pain / Q000188:drug therapy; D011184:Postoperative Period; D000077149:Sevoflurane
chemical_list: D000701:Analgesics, Opioid; D016207:Cytokines; D008738:Methyl Ethers; D000077149:Sevoflurane; D005283:Fentanyl
keywords: Analgesia, epidural; Anesthesia; Innate immunity; Lung cancer; Natural killers non-small cell lung cancer