Effect of Combined General/Epidural Anesthesia on Postoperative NK Cell Activity and Cytokine Response in Gastric Cancer Patients Undergoing Radical Resection.

Background/aims: Emerging evidence has shown that epidural anesthesia could reduce the excessive stress response after surgery, and may help to preserve the body's defenses against tumor progression in comparison with general anesthesia in malignant patients receiving operation. This study aims to evaluate the effect of epidural anesthesia on postoperative immune suppression in gastric cancer patients undergoing radical resection.

Methodology: Seventy one gastric cancer patients receiving radical resection were randomized to combined general/epidural anesthesia (study group) or general anesthesia alone (control group). Natural killer cell activity and serum concentrations of protumorigenic cytokines IL-1β and IL-6, and antitumorigenic cytokines IL-2 and IL-10 were measured before anesthesia (T1), 4h after skin incision (T2), and 24h after skin incision (T3) in both groups.

Results: In both groups, the concentrations of IL-10, IL-6, and IL-10 increased at T2 and T3 when compared with T1, whereas IL-2 concentration and NK cell activity decreased at T2 and T3. Furthermore, the study group exhibited less suppression of NK cell activity, higher levels of IL-2 and IL-10, and lower levels of IL-1β and IL-6 in the early stage after operation, compared with the control group. CONCLUSIOns: Combined general/epidural anesthesia seems to helpful to maintain the body's perioperative immune function compared to general anesthesia alone in patients with gastric cancer operation.