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

Efremov, Sergey; Kozireva, Victoria Sergeevna; Мороз, Г. Б.; Abubakirov, Marat; Шкода, О.С.; Шилова, А. Н.; Yarmoshuk, Sergey Valeriyevich; Zheravin, Alexandr Alexandrovich; Landoni, Giovanni; Ломиворотов, В. В.

doi:10.4097/kja.19461

Cited by 6 publications

(7 citation statements)

References 24 publications

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“…Furthermore, most recent clinical studies did not identify differences in cancer progression, recurrence, or metastasis between propofol-and volatile anesthetic-based anesthesia. 8,12,[40][41][42] The main limitation of most in vitro studies is that they did not faithfully replicate the in vivo conditions of the cancer microenvironment, which may be responsible for the discrepant results of numerous previous studies regarding the potential antitumor effects of propofol. We did not find any differences in the fractions of immune cells between propofol-and sevoflurane-based anesthesia in the current study.…”

Section: Perioperative Medicinementioning

confidence: 99%

“…However, the results remain controversial, and the antitumor effects of propofol have not been confirmed. 8 Colorectal cancer is a commonly diagnosed cancer and a leading cause of cancer-related mortality. The hazardous effects of volatile anesthetics on colorectal cancer have been investigated in several in vitro studies.…”

Section: What This Article Tells Us That Is Newmentioning

confidence: 99%

“…However, the results remain controversial, and the antitumor effects of propofol have not been confirmed. 8…”

mentioning

confidence: 99%

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Expression Profiles of Immune Cells after Propofol or Sevoflurane Anesthesia for Colorectal Cancer Surgery: A Prospective Double-blind Randomized Trial

Park

Piao

et al. 2022

Anesthesiology

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Background The antitumor effects of natural killer cells, helper T cells, and cytotoxic T cells after cancer surgery were reported previously. This study hypothesized that propofol-based anesthesia would have fewer harmful effects on immune cells than volatile anesthetics–based anesthesia during colorectal cancer surgery. Methods In total, 153 patients undergoing colorectal cancer surgery were randomized and included in the analysis. The primary outcome was the fraction of circulating natural killer cells over time in the propofol and sevoflurane groups. The fractions of circulating natural killer, type 1, type 17 helper T cells, and cytotoxic T cells were investigated. The fractions of CD39 and CD73 expressions on circulating regulatory T cells were investigated, along with the proportions of circulating neutrophils, lymphocytes, and monocytes. Results The fraction of circulating natural killer cells was not significantly different between the propofol and sevoflurane groups until 24 h postoperatively (20.4 ± 13.4% vs. 20.8 ± 11.3%, 17.9 ± 12.7% vs. 20.7 ± 11.9%, and 18.6 ± 11.6% vs. 21.3 ± 10.8% before anesthesia and after 1 and 24 h after anesthesia, respectively; difference [95% CI], –0.3 [–4.3 to 3.6], –2.8 [–6.8 to 1.1], and –2.6 [–6.2 to 1.0]; P = 0.863, P = 0.136, and P = 0.151 before anesthesia and after 1 and 24 h, respectively). The fractions of circulating type 1 and type 17 helper T cells, cytotoxic T cells, and CD39+ and CD73+ circulating regulatory T cells were not significantly different between the two groups. The neutrophil to lymphocyte ratio in both groups remained within the normal range and was not different between the groups. Conclusions Propofol-based anesthesia was not superior to sevoflurane-based anesthesia in terms of alleviating suppression of immune cells including natural killer cells and T lymphocytes during colorectal cancer surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Perioperative Medicinementioning

confidence: 99%

Section: What This Article Tells Us That Is Newmentioning

confidence: 99%

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Expression Profiles of Immune Cells after Propofol or Sevoflurane Anesthesia for Colorectal Cancer Surgery: A Prospective Double-blind Randomized Trial

Park

Piao

et al. 2022

Anesthesiology

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“…In addition, Liu et al (2016) found that the counts of CD3 + cells, CD4 + cells, NK cells, and the CD4+/CD8+ ratios were significantly lower in the sevoflurane group, which meant that the function of the lymphocyte subsets in cervical cancer patients undergoing radical hysterectomy seemed to be better in the presence of propofol than it is with sevoflurane. However, in kidney cancer surgery, a study analyzing the amount of NK cells, total T lymphocytes, regulatory T cells, T helper cells, cytotoxic T lymphocytes, and their subpopulations concluded that there were no significant differences between propofol and sevoflurane in many kinds of lymphocytes (Efremov et al, 2020).…”

Section: Other Cancersmentioning

confidence: 99%

The benefits of propofol on cancer treatment: Decipher its modulation code to immunocytes

Pan²,

Wang³

et al. 2022

Front. Pharmacol.

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Anesthetics are essential for cancer surgery, but accumulated research have proven that some anesthetics promote the occurrence of certain cancers, leading to adverse effects in the lives of patients. Although anesthetic technology is mature, there is no golden drug selection standard for surgical cancer treatment. To afford the responsibility of human health, a more specific regimen for cancer resection is indeed necessary. Immunosuppression in oncologic surgery has an adverse influence on the outcomes of patients. The choice of anesthetic strategies influences perioperative immunity. Among anesthetics, propofol has shown positive effects on immunity. Apart from that, propofol’s anticancer effect has been generally reported, which makes it more significant in oncologic surgery. However, the immunoregulative function of propofol is not reorganized well. Herein, we have summarized the impact of propofol on different immunocytes, proposed its potential mechanism for the positive effect on cancer immunity, and offered a conceivable hypothesis on its regulation to postoperative inflammation. We conclude that the priority of propofol is high in oncologic surgery and propofol may be a promising immunomodulatory drug for tumor therapy.

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“…The results showed that propofol was not superior to sevoflurane in the alleviation of the suppression of immune cells in colorectal cancer surgery (Oh et al, 2022). Another randomized controlled trial on the effect of volatile anesthesia (sevoflurane) versus intravenous anesthesia (propofol) on immunosuppression in renal cancer also showed that propofol was not effective in improving the immunosuppressive state of the tumor microenvironment (Efremov et al, 2020). Therefore, the regulatory effects of propofol on the immune system, including immune cell infiltration and expression of immune checkpoints, are still unclear and need to be further investigated, which will enrich the immunomodulatory role of propofol and provide a new direction for tumor immunotherapy.…”

Section: Regulation Of Immunitymentioning

confidence: 99%

An intravenous anesthetic drug-propofol, influences the biological characteristics of malignant tumors and reshapes the tumor microenvironment: A narrative literature review

Zhou

Shao

et al. 2022

Front. Pharmacol.

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Malignant tumors are the second leading cause of death worldwide. This is a public health concern that negatively impacts human health and poses a threat to the safety of life. Although there are several treatment approaches for malignant tumors, surgical resection remains the primary and direct treatment for malignant solid tumors. Anesthesia is an integral part of the operation process. Different anesthesia techniques and drugs have different effects on the operation and the postoperative prognosis. Propofol is an intravenous anesthetic that is commonly used in surgery. A substantial number of studies have shown that propofol participates in the pathophysiological process related to malignant tumors and affects the occurrence and development of malignant tumors, including anti-tumor effect, pro-tumor effect, and regulation of drug resistance. Propofol can also reshape the tumor microenvironment, including anti-angiogenesis, regulation of immunity, reduction of inflammation and remodeling of the extracellular matrix. Furthermore, most clinical studies have also indicated that propofol may contribute to a better postoperative outcome in some malignant tumor surgeries. Therefore, the author reviewed the chemical properties, pharmacokinetics, clinical application and limitations, mechanism of influencing the biological characteristics of malignant tumors and reshaping the tumor microenvironment, studies of propofol in animal tumor models and its relationship with postoperative prognosis of propofol in combination with the relevant literature in recent years, to lay a foundation for further study on the correlation between propofol and malignant tumor and provide theoretical guidance for the selection of anesthetics in malignant tumor surgery.

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

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record.

Cited by 6 publications

References 24 publications

Expression Profiles of Immune Cells after Propofol or Sevoflurane Anesthesia for Colorectal Cancer Surgery: A Prospective Double-blind Randomized Trial

Expression Profiles of Immune Cells after Propofol or Sevoflurane Anesthesia for Colorectal Cancer Surgery: A Prospective Double-blind Randomized Trial

The benefits of propofol on cancer treatment: Decipher its modulation code to immunocytes

An intravenous anesthetic drug-propofol, influences the biological characteristics of malignant tumors and reshapes the tumor microenvironment: A narrative literature review

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