Effects of surgery, general anesthesia, and perioperative epidural analgesia on the immune function of patients with non-small cell lung cancer

Study 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. Design: Observational single-center study. Setting: University-affiliated academic center. Patients: 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. Interventions: Patients underwent thoracotomy with general anesthesia and postoperative epidural analgesia. Measurements: 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 T(H)1 cytokine interleukin-2 and interferon-gamma and the T(H)2 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 T(H)1/T(H)2 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. (c) 2013 Elsevier Inc. All rights reserved.