Long-term survival for patients with pancreatic carcinoma is low, even following resection,
the 5-year survival rate of patients ranges from 10 to 25%1. Most treatment failure is due to
local recurrence, distant metastasis or both within one to two years after surgery2-4.
Surgery has been suggested to accelerate the development of preexisting micro metastases and
to promote the establishment of new metastases5. Release of catecholamine and proinflammatory
products secondary to surgical stress is believed to promote cancer progression6. Maintenance
of proper anesthetic depth is beneficial to attenuate surgical stress. However, general
anesthesia including numerous induction agents, volatile anesthetics and opioids, is
associated with immunosuppression especially on the cell-mediated immunity which has a
crucial role in prevention of micrometastasis5,7. Therefore, regional anesthesia and
analgesia which effectively attenuating surgical stress while efficiently reducing general
anesthetics consumption, seem to provide promising advantages to prevent perioperative cancer
progression. Currently, most studies available in humans are retrospective and observational
to evaluate regional anesthesia and prostate, colorectal, breast and cervical cancer-related
outcomes8-12. Only one randomized study investigating major abdominal cancer surgery is
available13. However, it is not specific to an individual cancer type and perioperative
cell-mediated immunity is not evaluated.
In this study, we aimed to identify whether epidural block beneficial to early surgical and
late cancer-related outcomes in patients receiving pancreatic cancer surgery. Perioperative
cell-mediated immunity functions including natural killer cells, helper and cytotoxic
T-lymphocytes were also investigated.