Effects of anesthetic methods on preserving anti-tumor T-helper polarization following hepatectomy

World J Gastroenterol. 2012 Jun 28;18(24):3089-98. doi: 10.3748/wjg.v18.i24.3089.


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.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anesthesia, Epidural* / adverse effects
  • Anesthesia, General* / adverse effects
  • Biomarkers / blood
  • Carcinoma, Hepatocellular / blood
  • Carcinoma, Hepatocellular / immunology
  • Carcinoma, Hepatocellular / surgery*
  • China
  • Cytokines / blood
  • Cytokines / genetics
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Flow Cytometry
  • Hepatectomy* / adverse effects
  • Humans
  • Liver Neoplasms / blood
  • Liver Neoplasms / immunology
  • Liver Neoplasms / surgery*
  • Lymphocytes, Tumor-Infiltrating / immunology*
  • Male
  • Middle Aged
  • Real-Time Polymerase Chain Reaction
  • Reverse Transcriptase Polymerase Chain Reaction
  • T-Lymphocytes, Helper-Inducer / immunology*
  • T-Lymphocytes, Regulatory / immunology
  • Th1 Cells / immunology
  • Th17 Cells / immunology
  • Th2 Cells / immunology
  • Time Factors
  • Treatment Outcome


  • Biomarkers
  • Cytokines