The immunosuppressive effects of volatile versus intravenous anesthesia combined with epidural analgesia on kidney cancer: a pilot randomized controlled trial

Background: The aim of this study was to test the hypothesis that the suppression of the cell-mediated immunity is worse under the use of inhalational anesthesia as compared to total intravenous anesthesia, in patients undergoing kidney cancer surgery under combined low thoracic epidural analgesia and general anesthesia. Methods: Patients were randomly allocated to either propofol-based (intravenous anesthetic) or sevoflurane-based (volatile anesthetic) anesthesia group with 10 patients in each group, along with epidural analgesia in both the groups. Frequencies of natural killer cells, total T lymphocytes, and T lymphocyte subpopulations in the blood samples collected from the patients before surgery, at the end of the surgery and postoperative days 1, 3, and 7, were determined by flow cytometric analysis. The primary end point of the study was natural killer (NK) cell count and the secondary end point was the total T lymphocyte count and cell counts for T lymphocyte subpopulations. Results: Our study showed that there were no significant differences in the frequency of NK cells, total T lymphocytes, regulatory T cells, and T-helper cells, cytotoxic T lymphocytes, and their subpopulations between the propofol-based and sevoflurane-based anesthesia group, when the anesthesia was administered in combination with epidural analgesia. Conclusions: The results of the current pilot study did not support the hypothesis that the suppression of the cell-mediated immunity is worse under the use of inhalational anesthesia as compared to total intravenous anesthesia, in patients undergoing kidney cancer surgery under combined low thoracic epidural analgesia and general anesthesia.