Original Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jun 28, 2012; 18(24): 3089-3098
Published online Jun 28, 2012. doi: 10.3748/wjg.v18.i24.3089
Effects of anesthetic methods on preserving anti-tumor T-helper polarization following hepatectomy
Di Zhou, Fang-Ming Gu, Qiang Gao, Quan-Lin Li, Jian Zhou, Chang-Hong Miao
Di Zhou, Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Fang-Ming Gu, Qiang Gao, Quan-Lin Li, Jian Zhou, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Fang-Ming Gu, the Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
Jian Zhou, Institute of Biomedical Sciences, Fudan University, Shanghai 200032, China
Chang-Hong Miao, Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Author contributions: Zhou D, Gu FM and Gao Q contributed equally to this work; Zhou J and Miao CH designed the research; Zhou D, Gu FM and Gao Q performed the research; Gao Q and Li QL analyzed the data; Zhou D and Gao Q drafted the paper; Zhou J and Miao CH critically revised the paper with important conceptual and editorial input.
Supported by The State 863 High Technology R and D Project of China, No. 2007AA02Z479; National Natural Science Foundation of China, No. 30972949; Shanghai Rising-Star Program, No. 10QA1401300; FANEDD, No. 201183; Science and Technology Commission of Shanghai Municipality, No. 114119a4400; and Shanghai “Chen Guang” Project, No. 11CG02
Correspondence to: Dr. Chang-Hong Miao, MD, PhD, Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China. miaochh@yahoo.com.cn
Telephone: +86-21-64037181 Fax: +86-21-64037181
Received: September 24, 2011
Revised: March 20, 2012
Accepted: April 9, 2012
Published online: June 28, 2012
Abstract

AIM: To investigate the impact of different anesthetic techniques on T-helper (Th) cell subsets in hepatocellular carcinoma (HCC) patients undergoing hepatectomy.

METHODS: Sixty-one HCC patients who received hepatectomies were randomized into an epidural combined general anesthesia (G + E; n = 31) or a general anesthesia (G; n = 30) group. Blood samples were obtained the morning before the operation (d0), and on the second (d2) and seventh (d7) day after the operation. Th cell contents were evaluated using flow cytometry, real-time reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay.

RESULTS: In all 61 patients, Th1 and Th2 cell frequencies, and interferon-γ (IFN-γ) mRNA expression markedly increased on d2, compared to d0. They recovered slightly on d7, and the Th1/Th2 ratio increased markedly on d7, compared with d2. In contrast, Th17, regulatory T cell (Treg), and interleukin-17 (IL-17) levels and FOXP3 mRNA expression showed no significant change on d2, and then markedly decreased on d7. Similarly, plasma IFN-γ concentration on d2 was much higher than that on d0, and then partly recovered on d7. As compared with the G group, in the G + E group, Th1 cell frequencies and the Th1/Th2 ratio were slightly higher on d2 and significantly higher on d7, while Th2, Th17, and Treg cell frequencies were slightly lower on d2, and significantly lower on d7. Consistently, on d7, IFN-γ mRNA and protein levels and the IFN-γ/IL-4 ratio in the G + E group were higher than those in the G group. In contrast, the IL-17 mRNA level, and IL-17 and transforming growth factor-β1 concentrations in the G + E group were lower than those in the G group.

CONCLUSION: G + E is superior to G in shifting the Th1/Th2 balance towards Th1, while decreasing Th17 and Treg, potentially benefiting HCC patients by promoting anti-tumor Th polarization.

Keywords: Epidural anesthesia, General anesthesia, Hepatocellular carcinoma, T-helper cell, Tumor resection