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Immunomodulatory effects of total intravenous and balanced inhalation anesthesia in patients with bladder cancer undergoing elective radical Cystectomy: preliminary results

Maria Sofra1, Paola Cordiali Fei2, Luana Fabrizi1, Maria Elena Marcelli1, Claudia Claroni1, Michele Gallucci3, Fabrizio Ensoli2 and Ester Forastiere1*

Author Affiliations

1 Department of Anesthesiology, Regina Elena, Rome National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy

2 Department of Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, Rome, Italy

3 Department of Urology, Regina Elena, Rome National Cancer Institute, Rome, Italy

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Journal of Experimental & Clinical Cancer Research 2013, 32:6  doi:10.1186/1756-9966-32-6

Published: 3 February 2013



Although surgery and anesthesia induce immunesuppression, remains largely unknown whether various anesthetic techniques have different immunosuppressive effects on cancer patients. Therefore, the aim of this study was to investigate the influence of total intravenous anesthesia with target-controlled infusion (TIVA-TCI) and balanced inhalation anesthesia (BAL) on the peri-operative levels of inflammatory cytokines and regulatory T cells (Tregs) in patients with bladder cancer undergoing surgery.


Twenty eight consecutive patients with bladder cancer who underwent radical cystectomy were prospectively randomized into two groups to receive TIVA-TCI (n = 14) or BAL (n = 14). Before the induction of anesthesia (T0), 6–8 hours (T1) post-surgery, and 5 days post-surgery (T2), Tregs and serum levels of interleukin -1beta (IL-1β), interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukin −2 (IL-2), interleukin −6 (IL-6), and interleukin −10 (IL-10) were measured.


In the peri-operative period all cancer patients showed a marked and significant increase in IL-6. Moreover, TIVA-TCI patients also showed a higher increase in IFN-γ, whereas in BAL patients Tregs were reduced by approximately 30% during surgery. The incidence of infections, metastases, and death was similar in both groups.


The increase in the Th1 response in the TIVA-TCI group and the reduction in Tregs in the BAL group seem to balance the immunosuppressive effect induced by IL-6. Therefore TIVA-TCI and BAL can be both used in major surgery in patients with bladder cancer without worsening the outcome.

Total intravenous anesthesia with target-controlled infusion (TIVA-TCI); Balanced inhalation anesthesia (BAL); Urinary bladder carcinoma; Cytokines; Tregs