Konstantis Georgios, Tsaousi Georgia, Kitsikidou Elisavet, Zacharoulis Dimitrios, Pourzitaki Chryssa
Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany.
J Clin Med. 2023 Sep 18;12(18):6027. doi: 10.3390/jcm12186027.
Gastric and colorectal carcinomas are associated with increased mortality and an increasing incidence worldwide, while surgical resection remains the primary approach for managing these conditions. Emerging evidence suggests that the immunosuppression induced by the chosen anaesthesia approach, during the perioperative period, can have a significant impact on the immune system and consequently the prognosis of these patients.
This systematic review aims to comprehensively summarize the existing literature on the effects of different anaesthesia techniques on immune system responses, focusing on cellular immunity in patients undergoing the surgical removal of gastric or colorectal carcinomas. There is no meta-analysis investigating anaesthesia's impact on immune responses in gastric and colorectal cancer surgery. Anaesthesia is a key perioperative factor, yet its significance in this area has not been thoroughly investigated. The clinical question of how the anaesthetic technique choice affects the immune system and prognosis remains unresolved.
Major electronic databases were searched up to February 2023 to May 2023 for relevant randomized controlled trials (RCTs). The study protocol has been registered with Prospero (CRD42023441383).
Six RCTs met the selection criteria. Among these, three RCTs investigated the effects of volatile-based anaesthesia versus total intravenous anaesthesia (TIVA), while the other three RCTs compared general anaesthesia alone to the combination of general anaesthesia with epidural anaesthesia. According to our analysis, there were no significant differences between TIVA and volatile-based anaesthesia, in terms of primary and secondary endpoints. The combination of general anaesthesia with epidural analgesia had a positive impact on NK cell counts (SMD 0.61, 95% CI 0.28 to 0.94, I 0.0% at 24 and 72 h after the operation), as well as on CD4 cells (SMD 0.59, CI 95% 0.26 to 0.93, I 0.0%). However, the CD3 cell count, CD4/CD8 ratio, neutrophil-to-lymphocyte ratio (NLR), IL-6 and TNF-α levels remained unaffected.
The combination of epidural analgesia and general anaesthesia can potentially improve, postoperatively, the NK cell count and CD4 cell levels in gastric or colon surgery patients. However, the specific impact of TIVA or volatile-based anaesthesia remains uncertain. To gain a better understanding of the immunomodulatory effects of anaesthesia, in this particular group of cancer patients, further well-designed trials are required.
胃癌和结直肠癌在全球范围内与死亡率增加和发病率上升相关，而手术切除仍然是治疗这些疾病的主要方法。新出现的证据表明，围手术期所选麻醉方法诱导的免疫抑制会对免疫系统产生重大影响，进而影响这些患者的预后。
本系统评价旨在全面总结现有关于不同麻醉技术对免疫系统反应影响的文献，重点关注接受胃癌或结直肠癌手术切除患者的细胞免疫。尚无荟萃分析研究麻醉对胃癌和结直肠癌手术中免疫反应的影响。麻醉是围手术期的一个关键因素，但其在该领域的重要性尚未得到充分研究。麻醉技术选择如何影响免疫系统和预后这一临床问题仍未解决。
检索主要电子数据库至2023年2月至2023年5月的相关随机对照试验（RCT）。该研究方案已在国际前瞻性系统评价注册库（Prospero）注册（CRD42023441383）。
六项RCT符合入选标准。其中，三项RCT研究了挥发性麻醉与全静脉麻醉（TIVA）的效果，另外三项RCT比较了单纯全身麻醉与全身麻醉联合硬膜外麻醉的效果。根据我们的分析，在主要和次要终点方面，TIVA与挥发性麻醉之间没有显著差异。全身麻醉与硬膜外镇痛联合使用对自然杀伤细胞（NK细胞）计数有积极影响（标准化均数差0.61，95%可信区间0.28至0.94，术后24小时和72小时I²为0.0%），对CD4细胞也有积极影响（标准化均数差0.59，95%可信区间0.26至0.93，I²为0.0%）。然而，CD3细胞计数、CD4/CD8比值、中性粒细胞与淋巴细胞比值（NLR）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平未受影响。
硬膜外镇痛与全身麻醉联合使用可能会在术后改善胃癌或结肠癌手术患者的NK细胞计数和CD4细胞水平。然而，TIVA或挥发性麻醉的具体影响仍不确定。为了更好地了解麻醉在这一特定癌症患者群体中的免疫调节作用，需要进一步设计良好的试验。
