title: General anesthesia combined with epidural anesthesia ameliorates the effect of fast-track surgery by mitigating immunosuppression and facilitating intestinal functional recovery in colon cancer patients.
abstract: OBJECTIVE
  The purpose of this study is to investigate the influence of anesthetic methods on markers of anti-tumor immunity and intestinal functions in fast-track surgery in colon cancer (CC) patients during the perioperative period.
  
  
  METHODS
  A total of 53 patients with American Society of Anesthesiologists (ASA) I-II status randomly received general anesthesia (G group, n = 27) or general anesthesia combined with epidural anesthesia (E group, n = 26) for surgical tumor resection. The recovery times of intestinal function were evaluated in both groups postoperatively. The frequencies of different subsets of CD4+ T cells and myeloid-derived suppressor cells and C-reactive protein (CRP) were measured by flow cytometry and enzyme-linked immunosorbent assay, respectively, before anesthesia (t0), 1 h after the beginning of surgery (t1), 1 h after the end of surgery (t2), and on day 2 (t3) and day 5 (t4) post-surgery.
  
  
  RESULTS
  There was no significant difference in demographic characteristics between the two groups, but the E group of patients received significantly lower amounts of morphine and sevoflurane. In comparison with those in the G group, significantly greater numbers of lymphocytes and elevated frequencies of Th1 cells were detected at t3 and t4 post-surgery in the E group (p < 0.01). Significantly lower percentages of Th2 cells and regulatory T cells were detected in the E group at t2-4 post-surgery. Whereas the levels of plasma CRP increased post-surgery in both groups, the levels of CRP were significantly lower in the E group than those in the G group at t3-4 post-surgery (p < 0.05). The times to the first flatus and to tolerate a full diet were significantly shorter in the E group than those in the G group (p < 0.01).
  
  
  CONCLUSIONS
  General anesthesia combined with epidural anesthesia plays an important role in fast-track surgery, mitigating the surgical stress-related impairment of anti-tumor immune responses and hastening the recovery of intestinal function. This combination might also help to improve long-term outcomes for CC patients.
authors.affiliation: Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
authors.forename: Wan-Kun
authors.initials: WK
authors.lastname: Chen
authors.forename: Li
authors.initials: L
authors.lastname: Ren
authors.forename: Ye
authors.initials: Y
authors.lastname: Wei
authors.forename: De-Xiang
authors.initials: DX
authors.lastname: Zhu
authors.forename: Chang-Hong
authors.initials: CH
authors.lastname: Miao
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Xu
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D002097:C-Reactive Protein / Q000378:metabolism; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism; D003110:Colonic Neoplasms / Q000276:immunology* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D045823:Ileus / Q000503:physiopathology; D007108:Immune Tolerance; D007422:Intestines / Q000502:physiology*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D022423:Myeloid Cells / Q000276:immunology; D011183:Postoperative Complications / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function; D000077149:Sevoflurane
chemical_list: D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D009020:Morphine; D002097:C-Reactive Protein