Background and Objectives: Local and systemic inflammation is common after surgery and is associated with morbidity and mortality. Inflammatory cytokines have been implicated in cancer metastasis following cancer surgery. The present study aimed to analyze inflammatory cytokines levels after surgery under combined epidural/general anesthesia (EA + GA) vs. general anesthesia (GA). Methods: We systematically searched PubMed, Central, EMBASE, CINAHL, Google Scholar, and Web of Science citation indexes for clinical studies (cancer and non-cancer surgery) comparing the two techniques. We carried out a meta-analysis to evaluate the postoperative plasma levels of cytokines, C-reactive protein (CRP), and cortisol levels. Results: The literature search was last updated on 2 January 2025. We identified a total of 21 studies which compared postoperative inflammatory mediators with EA plus GA compared to GA alone. EA plus GA was associated with significantly lower serum levels of IL-6, TNF-α, CRP, as well as cortisol and other pro-inflammatory cytokines. In cancer surgery, EA plus GA was also associated with lower postoperative cytokines. Conclusions: Our meta-analysis indicates that EA plus GA is associated with diminished postoperative inflammatory response. This offers an alternative explanation for the benefit of epidural analgesia on postoperative outcomes. Considering the link between postoperative inflammation and recurrence after cancer surgery, this is an area that warrants further research.
背景与目的：术后局部及全身性炎症反应较为常见，并与并发症及死亡率相关。炎性细胞因子被认为与肿瘤术后转移有关。本研究旨在分析联合硬膜外/全身麻醉（EA+GA）与单纯全身麻醉（GA）术后炎性细胞因子水平差异。方法：我们系统检索了PubMed、Central、EMBASE、CINAHL、Google Scholar及Web of Science引文数据库中比较两种麻醉方式的临床研究（涵盖肿瘤与非肿瘤手术）。通过荟萃分析评估术后血浆细胞因子、C反应蛋白（CRP）及皮质醇水平。结果：文献检索截止于2025年1月2日。共纳入21项比较EA联合GA与单纯GA术后炎症介质水平的研究。EA联合GA组血清IL-6、TNF-α、CRP、皮质醇及其他促炎细胞因子水平显著降低。在肿瘤手术中，EA联合GA同样与术后细胞因子水平降低相关。结论：本荟萃分析表明EA联合GA可减轻术后炎症反应，这为硬膜外镇痛改善术后结局提供了新的解释视角。鉴于术后炎症与肿瘤术后复发存在关联，该领域值得进一步深入研究。
肿瘤(癌症)患者之家