Perioperative immunosuppressants, such as surgical stress and opioid use may downregulate anti-cancer immunocytes for patients undergoing pancreatectomy. Thoracic epidural analgesia (TEA) may attenuate these negative effects and provide better anti-cancer immunocyte profile change than intravenous analgesia using opioid. We randomly assigned 108 adult patients undergoing pancreatectomy to receive one of two 72-h postoperative analgesia protocols: one was TEA, and the other was intravenous patient-controlled analgesia (IV-PCA). The perioperative proportional changes of immunocytes relevant to anticancer immunity—namely natural killer (NK) cells, cytotoxic T cells, helper T cells, mature dendritic cells, and regulatory T (Treg) cells were determined at 1 day before surgery, at the end of surgery and on postoperative day 1,4 and 7 using flow cytometry. In addition, the progression-free survival and overall survival between the two groups were compared. After surgery, the proportions of NK cells and cytotoxic T cells were significantly decreased; the proportion of B cells and mature dendritic cells and Treg cells were significantly increased. However, the proportions of helper T cells exhibited no significant change. These results were comparable between the two groups. Furthermore, there were no significant differences in progression-free survival (52.75 [39.96] and 57.48 [43.66] months for patients in the TEA and IV–PCA groups, respectively; = 0.5600) and overall survival (62.71 [35.48] and 75.11 [33.10] months for patients in the TEA and IV–PCA groups, respectively; = 0.0644). TEA was neither associated with favorable anticancer immunity nor favorable oncological outcomes for patients undergoing pancreatectomy.

中文翻译：

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胰腺切除术后接受硬膜外镇痛与静脉镇痛的患者的免疫细胞谱变化：一项随机对照试验

围手术期免疫抑制剂，例如手术应激和阿片类药物的使用，可能会下调接受胰腺切除术的患者的抗癌免疫细胞。胸段硬膜外镇痛 (TEA) 可以减轻这些负面影响，并比使用阿片类药物的静脉镇痛提供更好的抗癌免疫细胞谱变化。我们随机分配 108 名接受胰腺切除术的成年患者接受两种 72 小时术后镇痛方案中的一种：一种是 TEA，另一种是静脉患者自控镇痛 (IV-PCA)。术前1天、手术结束时测定与抗癌免疫相关的免疫细胞——即自然杀伤（NK）细胞、细胞毒性T细胞、辅助性T细胞、成熟树突状细胞和调节性T（Treg）细胞的围手术期比例变化。手术中和术后第 1、4 和 7 天使用流式细胞术。此外，还比较了两组的无进展生存期和总生存期。手术后，NK细胞和细胞毒性T细胞的比例明显下降； B细胞、成熟树突状细胞和Treg细胞的比例显着增加。然而，辅助T细胞的比例没有表现出显着变化。两组之间的这些结果具有可比性。此外，TEA 组和 IV-PCA 组患者的无进展生存期（分别为 52.75 [39.96] 和 57.48 [43.66] 个月；= 0.5600）和总生存期（62.71 [35.48] 和 75.11 [ TEA 组和 IV-PCA 组患者分别为 33.10] 个月；= 0.0644）。对于接受胰腺切除术的患者来说，TEA 既不与良好的抗癌免疫力相关，也不与良好的肿瘤学结果相关。