Effects of different anesthesia methods on patients undergoing laparoscopic radical resection of rectal cancer: a retrospective study

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Patients' general information, hospital moriality and surgical complications were recorded. The immunological indexes and inflammatory factor levels of patients were dynamically recorded before surgery, and at the first, third and fifth days after surgery. Compared with groups A and C, the intraoperative dosage of propofol, remifentanil and cisatracurium in group B was lower (p < 0.05), the number of vasoactive drug users and the incidence of postoperative chills were lower (p< 0.05), the probability of vomiting was lower in group B and group C; The cell counts of CD3 + T, CD4 + T, CD4/CD8 and NK in group B were higher than those in group A and C on day 1 and day 3 after surgery (p < 0.05), the CD3 + T, CD4 + T and NK cell counts of group C were higher than those of group A on the first and third days after surgery, while the IL-6, CRP, WBC and IFN-a counts of group B and C were lower than those of group A. Groups B and C had lower postoperative pain scores, lower use of postoperative analgesics, and shorter hospital times. General anesthesia combined epidural block can reduce postoperative immunosuppression and inflammatory response in patients with rectal cancer, and reduce intraoperative anesthetic drug dosage and adverse anesthesia reactions. Biological sciences/Biophysics Biological sciences/Biotechnology Biological sciences/Neuroscience Biological sciences/Physiology rectal cancer Immunosuppression Postoperative pain Inflammatory response Figures Figure 1 Figure 2 Figure 3 Introduction With the change of China's social lifestyle and the deepening of population aging, the incidence of tumors is increasing year by year, especially abdominal tumors, among which colon cancer and rectal cancer have become the main prevalent abdominal tumors [1-3], and the incidence gradually shows a younger trend, which has become one of the serious threats to people's health. The treatment of abdominal tumors can be divided into surgical therapy, chemotherapy, radiation therapy and immunotherapy. Although the treatment methods and methods are diversified, the five-year survival rate and long-term quality of life of rectal cancer have not been greatly improved. Surgical treatment is the main treatment method to improve the long-term survival rate of patients with rectal cancer, and laparoscopic radical resection of colorectal cancer is the main surgical treatment [4, 5]. Surgery will cause severe surgical stress, often leading to aggravated organ damage and severe immunosuppression, and postoperative pain is also a problem that cannot be ignored. These factors will increase perioperative complications and affect long-term prognosis, so it is crucial to choose the appropriate anesthesia method [6, 7]. However, there is no uniform anesthesia method for laparoscopic colorectal cancer resection. Is one of the most common surgical procedure, general anesthesia with intraoperative safe and comfortable, and the advantages of small trauma, and is often accompanied by respiratory tract obstruction, the complications such as respiratory depression, pulmonary infection, hypertension, epidural anesthesia is refers to the use of local anesthesia drugs block in patients with nerve root, can reduce postoperative pain, reduce pulmonary complications such as advantage; Transversal plane block has the advantages of reducing postoperative pain and accelerating postoperative recovery [8-10]. Therefore, in order to reduce immune damage and postoperative pain caused by surgery, and reduce perioperative complications, it is very important to select appropriate anesthesia methods. By accessing the electronic medical record system, we conducted a retrospective study on patients undergoing laparoscopic radical resection of colorectal cancer admitted to the anesthesia surgery Department of Huaian First People's Hospital Affiliated to Nanjing Medical University from 2016 to 2022. Through the analysis of different anesthesia in patients with general information, intraoperative anesthetic drug, adverse reaction to anesthesia, postoperative pain, complications, and the level of immunity and inflammation dynamic change, in order to choose the right means of anesthesia. 1. Materials and Methods 1.1 General Information and Grouping: A total of 360 patients with complete data who underwent laparoscopic radical resection of rectal cancer in the Department of Anesthesia and Surgery of Huai 'an First People's Hospital Affiliated to Nanjing Medical University from 2015 to 2021 were collected. The general data of the patients were recorded, including age, gender, past medical history, length of hospital stay, anesthesia method, postoperative extubation time, postoperative recovery time, etc. The patients were divided into general anesthesia group (A group), general anesthesia combined epidural block group (B group) and general anesthesia combined transversus abdominis block group (C group ). 1.2 Anesthesia methods: Fasting for 12h and water prohibition for 6 hours were performed before surgery. Vital signs and other tests were improved after patients entered the operating room. Peripheral veins were opened, balanced salt solution was injected, and internal jugular vein and radial artery puncture were performed after intravenous injection of rirenecil 0.04mg/kg and sufentanil 0.1ug/kg, and peripheral blood pressure was monitored. The general anesthesia group was induced and maintained by intravenous anesthesia. Epidural block combined with general anesthesia group: EB catheterization was performed at the 2-3 plane of lumbar spine, 2ml lidocaine was injected, and the pain plane was observed 5min later, and additional drug dosage was added if necessary, and then general intravenous anesthesia was performed after the effect. The transversal block combined with general anesthesia group: Under the guidance of color ultrasound, the transversal block was given 20ug injection of ropivacaine, and general anesthesia was performed after the completion of the transversal block. Observe the changes of blood pressure and heart rate during the operation, and deal with the drastic changes in blood pressure in time. 1.3 Inclusion criteria: 1) patients with indications for laparoscopic resection of rectal cancer, 2) patients aged ≥50 years, 3) patients with complete postoperative medical records and able to perform postoperative evaluation; 1.4 Exclusion criteria: 1) patients with previous disorders of consciousness, such as mental disorders, mental retardation, etc., 2) patients with previous open surgery or laparoscopic surgery ward, 3) patients with more loss of clinical data, 4) patients with obvious immunodeficiency. 1.5 Data collection: General data of patients were recorded, including patient's age, gender, preoperative ASA grading, previous medical history, length of hospital stay, anesthesia method, anesthesia time, postoperative extubation time, postoperative recovery time, postoperative pain score, etc. Postoperative complications of patients were recorded, and lymphocyte subsets and inflammatory factor values of patients were dynamically recorded before surgery and the first, third and fifth days after surgery. 1.5 Data analysis: SPSS 19.0 software was used for data analysis, and Grapaphd 8 was used for drawing. Means and standard deviations were used when data were normally distributed, and medians and quartiles were used when data were not normally distributed. Independent sample t test or Mann-Whitney U test was used to compare the data between the two groups according to the results of normality test. Count data were expressed as n (%), X 2 test was used for comparison between groups, Pearson or Spearman correlation test was used for correlation between two continuous variables, continuous dynamic analysis (GEE) was used to analyze continuous dynamic indicators, P≤0.05 was considered statistically significant. 2. Result 2.1 General information of the patients A total of 805 patients underwent laparoscopic radical resection of rectal cancer in the Affiliated Huaian Hospital of Nanjing Medical University by searching electronic cases. Through screening, a total of 360 patients with complete data were included in the study. According to different anesthesia methods, they were divided into three groups, with an average of 120 patients in each group, as shown in Figure 1. In this study, there were no differences among the three groups in terms of gender, age, history of hypertension, history of diabetes, history of coronary heart disease, ASA surgical classification, operation time, and anesthesia time, as shown in Table 1. Table1：baseline of patients Varibles A group（n=120） B group（n=120） C group（n=120） Sex Male 75（62.5%） 72（60%） 69（57.5%） Famale 45（37.5%） 48（40%） 51（42.5%） Hypertension 65（54.2%） 63（52.5%） 70（58.3%） Coronary heart disease 43（35.8%） 45（37.5%） 49（40.8%） Diabetes 43（35.8%） 38（31.7%） 40（33.3%） ASA grade（I、II级） 93（77.5%） 101（（84.2%） 96（80%） Duration of anesthesia（h） 2.62±0.36 2.51±0.35 2.65±0.12 Duration of surgery（h） 2.67±0.32 2.54±0.38 2.74±0.29 Age（years） 63.2±5.43 65.4±6.87 62.7±5.34 2.2 Intraoperative anesthetics and vasoactive drugs consumption Compared with the general anesthesia group and the general anesthesia combined transversus abdominis block group, the consumption of propofol, remifentanil, cisatracurium in the general anesthesia combined epidural block group was less, and the amount of vasoactive drugs during the operation was less. There was no significant difference in the dosage of anesthetic drugs during operation between the general anesthesia group and the general anesthesia combined transversus abdominis block group. There was no significant difference in the dosage of anesthetic drugs during operation and the amount of intraoperative blood loss among the three groups, as shown in Table 2. Table 2：Intraoperative anesthetics and vasoactive drugs consumption Varibles A group（n=120） B group（n=120） C group（n=120） Propofol（mg） 939.2±55.2 833.7±52.1ac 926±43.1 Remifentanil（mg） 622.8±36.8 552.4±34.7ac 552.4±34.7ac Dexmedetomidine（ug） 79.1±4.6 76.5±4.33 78±3.85 Cisatracurium（mg） 946.2±56.2 843.1±54.2ac 843.1±54.2 Sevoflurane 0.026±0.001 0.0238±0.0014ac 0.026±0.0011 Intraoperative blood loss（ml） 54.2±6.43 56.1±5.43 55.3±4.32 Vasoactive agents 18（15%） 9（7.5%）ac 15（12.5%） a represents the p< of group A compared with group B; 0.05; c represents the p< of group B compared with group C; 0.05 2.3 Adverse reactions of anesthesia Compared with the general anesthesia group and the general anesthesia combined transverse abdominis block group, the incidence of postoperative shivering in the general anesthesia combined epidural block group was lower. Compared with the patients in the general anesthesia group, the patients in the general anesthesia combined epidural block group and the general anesthesia combined transversus abbess block group had a lower probability of postoperative vomiting and a lower postoperative pain score (VAS score), and there was no difference in the incidence of anesthesia complications such as cough, restlessness, irritability, vision, and postoperative hypotension, as shown in Table 3. Table 3：Adverse reactions of anesthesia Varibles A group（n=120） B group（n=120） C group（n=120） Cough up 13（10.8%） 11（9.2%） 10(8.3%） agitation 23（19.2%） 18（15%） 24（20%） fidgety 24（20%） 21（17.5%） 26（21.7%） Vomiting 24（20%） 7（5.9%）a 11（9.2%）b VAS scores 6.54+0.45 5.43+0.67a 5.32+0.57b Postoperative observation 6（5%） 4（3.33%） 6（5%） Postoperative chills 23（19.2%） 6（5%）ac 18（18%） Wakefulness agent 17（14.2%） 15（12.5%） 20（16.7%） Postoperative hypotension 36（30%） 41（34.2%） 39（32.5%） a represents the group A compared with group B; p<0.05; c represents the group B compared with group C; p<0.05 2.4 Dynamic comparison of immune function There were no significant differences in CD3+T, CD4+T, CD4/CD8 and NK cell counts among the three groups before operation. Compared with the general anesthesia group and the general anesthesia combined transversus abdominis block group, the postoperative CD3+T, CD4+T, CD4/CD8 and NK cell counts were higher in the general anesthesia combined epidural block group on the first and third days after surgery (p<0.05). Compared with the general anesthesia group, the CD3+T, CD4+T and NK cell counts of the patients in the general anesthesia combined transverse abdominis block group were higher (p< 0.05). The CD3+T, CD4/CD8 and NK cell counts of patients in general anesthesia combined epidural block group and general anesthesia + transversus abdominis block group were higher than those in general anesthesia group on the 5th day after operation, as shown in Figure 2. The CRP, WBC and IFN-ɑ counts of patients in general anesthesia + epidural block group and general anesthesia combined transversus abdominis block group were lower than those in general anesthesia group on postoperative day 1 and 3. The IL-6 counts of patients in general anesthesia combined epidural block group and general anesthesia combined transversus abdominis block group were lower than those in general anesthesia group on postoperative day 1, 3 and 5. No differences in TNF-α counts were observed among the three groups at the three time nodes, as shown in Figure 3. 2.5 Postoperative Complications Compared with the general anesthesia group, the general anesthesia + epidural block group and general anesthesia + transversus abdominis block group had lower proportion of postoperative pain, fewer patients needed postoperative analgesia, and shorter length of hospital stay. There were no differences among the three groups in postoperative complications such as lower extremity deep vein thrombosis, incision infection, and gastrointestinal dysfunction, as shown in Table 4. Table 4：Postoperative Complications Varibles A group（n=120） B group（n=120） C group（n=120） Postoperative pain 28(23.3%) 12(10%)a 9(7.5%)b Deep vein thrombosis of lower extremity 13(10.8%) 15(12.5%) 14(11.7%) Analgesic equipment 20(16.7%) 7(5.8%)a 5(4.2%)b Incision infection 5(4.2%) 6(5%) 6(5%) Gastrointestinal dysfunction 6(5%) 4(3.3%) 4(3.3%) Postoperative hospital stay 8.76±1.21 6.76±0.78a 7.03±0.84b a represents the group A compared with group B,p<0.05; b represents the group A compare with group C,p<0.05;c represents the group B compared with group C; p<0.05 Discussion The incidence of rectal cancer is increasing year by year and has become one of the major abdominal tumors. Laparoscopic radical resection of rectal cancer is the main operation for patients with rectal cancer. In order to improve postoperative quality of life of patients with rectal cancer and reduce perioperative complications, this study was divided into three groups according to different anesthesia methods. A total of 360 patients with complete data who underwent laparoscopic radical resection for rectal cancer in the Department of Anesthesiology, Huaian First People's Hospital Affiliated to Nanjing Medical University from 2016 to 2021 were included to analyze the effects of different anesthesia methods on stress level, immune damage and postoperative complications. Immune function impairment and its complications may affect the prognosis of patients with rectal cancer, such as increasing the record of postoperative concurrent infections, resulting in weakness and prolonged hospital stay [11-13]. T lymphocytes play an important role in cellular immunity. CD3+T cells can reduce immune response, transmit immune signals to the body, and reduce the incidence of postoperative infection. CD4+ T lymphocytes mainly play an auxiliary killing role, and can be induced to differentiate into helper T (T helper) cells to participate in immune regulation under the action of various precursors [14, 15], while CD4/CD8 cells show abnormal cytophagocytosis function. Multiple studies have confirmed that the huge stress of surgery, local tissue damage, intestinal flora disorder and pain can lead to increased catecholamine hormone levels, thus activating the β2 adrenergic pathway, reducing the ability of T cells to secrete IFN-r, and reducing the toxic effects of CD8+T cells and NK cells [16、17]. Therefore, The continuous excitation of sympathetic nerve during the operation may be related to the injury of anti-tumor immune function. In this study, compared with patients under general anesthesia and transversal abdominal block, CD3+T, CD4+T, CD4/CD8, and NK cell counts in the general anesthesia + epidural block group on day 1 and day 3 after surgery were higher than those in the general anesthesia and transabdominal block group (p<0.05), compared with the general anesthesia group, CD3+T, CD4+T and NK cell counts were higher in the general anesthesia combined transverse abdominal block group (p<0.05). The number of CD3+T, CD4/CD8, and NK cells in the general anesthesia combined epidural block group and the general anesthesia combined transversal abdominal block group were higher than those in the general anesthesia combined transversal abdominal block group on the 5th day after surgery, indicating that compared with the general anesthesia group and the general anesthesia combined transversal abdominal block group, general anesthesia combined epidural block may help to reduce the damage of immune function during surgery and facilitate the postoperative recovery of patients. The level of stress response in perioperative period is often closely related to postoperative organ function injury and prognosis [18、19]. Reducing inflammatory response can also improve postoperative hospital stay and survival rate. IL-6 and CRP are relatively objective data reflecting the inflammatory response of the body, and IL-6 can reflect the severity of the disease in a variety of diseases [20-22], as well as the severe reaction of the disease. In this study, the level of IL-6 in the general anesthesia + epidural block group and the general anesthesia + transverse abdominal block group was lower than that in the general anesthesia + transverse abdominal block group at the 1st, 3rd and 5th day after surgery. IFN-a has antiviral, immune regulation and enhanced phagocytosis function of macrophages [23-25]. In a variety of non-viral diseases, the increased amount of IFN-a reflects the over-activation of immune function, which often means poor prognosis . In this study, The levels of IFN-a in the general anesthesia combined epidural block group and the general anesthesia combined transverse abdominal block group were lower than those in the general anesthesia combined transverse abdominal block group at 1, 3 and 5 days after surgery. Therefore, the results of this study suggest that compared with the general anesthesia group, general anesthesia plus epidural block and general anesthesia plus transverse abdominal muscle block can reduce the level of inflammatory response in patients, thereby reducing the level of organ damage and improving the quality of life in patients. Postoperative pain and chronic complications are common in patients with rectal cancer. Postoperative pain may delay the time for patients to get out of bed, leading to the incidence of postoperative lower extremity deep vein thrombosis and wound infection, while chronic pain may also lead to the incidence of postoperative depression and psychiatric problems [26-28]. In this study, compared with the general anesthesia group, the incidence of postoperative pain was lower in the general anesthesia combined epidural block group and the general anesthesia combined transverse abdominal block group, and fewer patients needed postoperative analgesic equipment, which shortened the length of hospital stay. Therefore, both the general anesthesia combined epidural block group and the general anesthesia combined transverse abdominal block group have the advantages of reducing postoperative pain and shortening hospital stay. At the same time, in terms of anesthesia drug use and anesthesia-related complications, compared with general anesthesia and general anesthesia combined transversal abdominal block group, general anesthesia combined epidural block group can reduce intraoperative anesthesia drug dosage and reduce the incidence of anesthesia-related complications, which is consistent with the results of previous studies on other diseases [29、30]. This study also has several limitations. First, as a single-center study, 360 surgical patients with complete data were included in the study, and there were problems of relatively uniform and small data volume. Second, the transversus abdominis block scheme used in this study was mostly TPAB, and RSB was not compared with the transversus abdominis block scheme, so there may be differences between two different abdominis block schemes. Conclusion Compared with the general anesthesia group and the general anesthesia combined abdominal transversal block group, general anesthesia combined epidural anesthesia can reduce postoperative immunosuppression and reduce the level of inflammation in rectal cancer patients, and the general anesthesia combined epidural anesthesia group can reduce the amount of intraoperative anesthesia drugs and reduce adverse anesthesia reactions. Compared with the general anesthesia group, Both general anesthesia plus epidural block and general anesthesia plus transversal block can reduce the incidence of postoperative pain. Declarations Authors' contributions All work was approved by the co-authors. LL and HX made significant contributions to conception and study design. LL、LYG and LM completed data acquisition. LL、LYG and LM performed data analysis and interpretation; LL、LYG and HX have written the draft of the article and critically revised it. No conflicts of interest exist in the submission of this manuscript. I would like to declare on behalf of my co-authors that the work described was original research that has not been published previously and is not under consideration for publication elsewhere, in whole or in part. All authors read and approved the final manuscript. Funding NO funding Support the research Funding Not applicable. Ethics approval and consent to participate All experiments in this study were carried out in accordance with the Declaration of Helsinki. This study was approved by the Ethical Committee of The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University. The data used in this study was anonymised before its use and were collected during routine procedures, which did not pose any additional risk to the patients. The requirement for informed consent by individual patients was waived by the Ethical Committee of The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University given the retrospective nature of the study. Availability of Data and Materials The datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request. Consent for publication Not applicable. Competing interest The authors declare that they have no confict of interest. 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Li Ya-Wei,Li Huai-Jin,Li Hui-Juan et al. Delirium in Older Patients after Combined Epidural-General Anesthesia or General Anesthesia for Major Surgery: A Randomized Trial.[J] .Anesthesiology, 2021, 135: 218-232. Zhang Shaoqiong,Gao Tianqi,Li Yuanyuan et al. Effect of combined epidural-general anesthesia on long-term survival of patients with colorectal cancer: a meta-analysis of cohort studies.[J] .Int J Colorectal Dis, 2022, 37: 725-735. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4812035","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":345664157,"identity":"2b2f813d-0ea2-4f0d-b9a6-f3ecf8b54de0","order_by":0,"name":"Xue He","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIie2RsarCMBRArxTqEnTN40n9hYhQ/Ag/IkFxqtAxg4hSaQd1d3gfURdxbAlkinvBpf5B3To42Hb1WTs65AyZcrg5NwAazRditr1I5ASjftuLU8oXn5UOkkyAO7IGOzkhqZKfFQs7QwEZH0Iytn9uG6PBw5AiwiWYrQ/mjLOVCd1gSyHnp5oW3xWHQgl+PZmwcw+wuoStnbrWTBFhhMopf3KWMGUCwfPQaPk1CqakUlaJY7vMN5ooUyIKpch3bGimIEnjoqVaMqZKorIlrmvpB57Issey+sp7zhdWN9gf05y/V15A5RE1v6/RaDSa/3gCl0JetJiaeDkAAAAASUVORK5CYII=","orcid":"","institution":"The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xue","middleName":"","lastName":"He","suffix":""},{"id":345664158,"identity":"852d11e5-bfce-4722-86fa-d5fb4ffe030e","order_by":1,"name":"Lin Li","email":"","orcid":"","institution":"The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Li","suffix":""},{"id":345664159,"identity":"0260f8a6-2239-4845-a06d-4a1a1db47db2","order_by":2,"name":"Yonggang Luo","email":"","orcid":"","institution":"The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yonggang","middleName":"","lastName":"Luo","suffix":""},{"id":345664160,"identity":"195a628f-381a-40e2-9b07-34ebf710d9c2","order_by":3,"name":"Min Liu","email":"","orcid":"","institution":"The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-07-27 08:39:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4812035/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4812035/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64146906,"identity":"29b1c66a-f221-4dbd-a29e-86369d37d70b","added_by":"auto","created_at":"2024-09-08 20:03:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":304708,"visible":true,"origin":"","legend":"\u003cp\u003ePatient enrollment standard\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4812035/v1/143513309b3adc5c71fb559e.png"},{"id":64146903,"identity":"4c211678-0b52-4724-a02a-cc80a87a2591","added_by":"auto","created_at":"2024-09-08 20:03:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":56411,"visible":true,"origin":"","legend":"\u003cp\u003eDynamic comparison of immune function\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e. Dynamic changes of CD3+T expression. \u003cstrong\u003eB\u003c/strong\u003e. Dynamic change of CD4+Texpression. \u003cstrong\u003eC\u003c/strong\u003e. Dynamic change of CD4/CD8 expression. \u003cstrong\u003eD\u003c/strong\u003e. Dynamic change of NK expression； a represents the group A compared with group B，p\u0026lt;0.05; c represents the group B compared with group C,p\u0026lt; 0.05\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4812035/v1/6c3bccc97d7fdd3d735946ec.png"},{"id":64146905,"identity":"0f569103-9876-4ab1-b50f-9f78aef670e3","added_by":"auto","created_at":"2024-09-08 20:03:27","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":68218,"visible":true,"origin":"","legend":"\u003cp\u003eDynamic comparison of Inflammator response\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e. Dynamic changes of CRP expression. \u003cstrong\u003eB\u003c/strong\u003e. Dynamic change of WBC expression. \u003cstrong\u003eC\u003c/strong\u003e. Dynamic change of IL-6 expression. \u003cstrong\u003eD\u003c/strong\u003e. Dynamic change of IFN- a expression. \u003cstrong\u003eE\u003c/strong\u003e. Dynamic changes of TNF-a expression level；a represents the group A compared with group B,p\u0026lt;0.05; b represents the group A compare with group C,p\u0026lt;0.05;c represents the group B compared with group C; p\u0026lt;0.05\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4812035/v1/8db70838caa30d3390ddb3e7.png"},{"id":77568875,"identity":"7cac7106-ed0a-42bb-9ac2-b68a853cc173","added_by":"auto","created_at":"2025-03-03 08:02:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":972023,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4812035/v1/1f5bf039-4535-4367-8f04-3c7771ca092b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of different anesthesia methods on patients undergoing laparoscopic radical resection of rectal cancer: a retrospective study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the change of China\u0026apos;s social lifestyle and the deepening of population aging, the incidence of tumors is increasing year by year, especially abdominal tumors, among which colon cancer and rectal cancer have become the main prevalent abdominal tumors [1-3], and the incidence gradually shows a younger trend, which has become one of the serious threats to people\u0026apos;s health. The treatment of abdominal tumors can be divided into surgical therapy, chemotherapy, radiation therapy and immunotherapy. Although the treatment methods and methods are diversified, the five-year survival rate and long-term quality of life of rectal cancer have not been greatly improved.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSurgical treatment is the main treatment method to improve the long-term survival rate of patients with rectal cancer, and laparoscopic radical resection of colorectal cancer is the main surgical treatment [4, 5]. Surgery will cause severe surgical stress, often leading to aggravated organ damage and severe immunosuppression, and postoperative pain is also a problem that cannot be ignored. These factors will increase perioperative complications and affect long-term prognosis, so it is crucial to choose the appropriate anesthesia method [6, 7]. However, there is no uniform anesthesia method for laparoscopic colorectal cancer resection. Is one of the most common surgical procedure, general anesthesia with intraoperative safe and comfortable, and the advantages of small trauma, and is often accompanied by respiratory tract obstruction, the complications such as respiratory depression, pulmonary infection, hypertension, epidural anesthesia is refers to the use of local anesthesia drugs block in patients with nerve root, can reduce postoperative pain, reduce pulmonary complications such as advantage; Transversal plane block has the advantages of reducing postoperative pain and accelerating postoperative recovery [8-10]. Therefore, in order to reduce immune damage and postoperative pain caused by surgery, and reduce perioperative complications, it is very important to select appropriate anesthesia methods.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBy accessing the electronic medical record system, we conducted a retrospective study on patients undergoing laparoscopic radical resection of colorectal cancer admitted to the anesthesia surgery Department of Huaian First People\u0026apos;s Hospital Affiliated to Nanjing Medical University from 2016 to 2022. Through the analysis of different anesthesia in patients with general information, intraoperative anesthetic drug, adverse reaction to anesthesia, postoperative pain, complications, and the level of immunity and inflammation dynamic change, in order to choose the right means of anesthesia.\u003c/p\u003e"},{"header":"1. Materials and Methods ","content":"\u003cp\u003e\u003cstrong\u003e1.1 General Information and Grouping: \u003c/strong\u003eA total of 360 patients with complete data who underwent laparoscopic radical resection of rectal cancer in the Department of Anesthesia and Surgery of Huai \u0026apos;an First People\u0026apos;s Hospital Affiliated to Nanjing Medical University from 2015 to 2021 were collected. The general data of the patients were recorded, including age, gender, past medical history, length of hospital stay, anesthesia method, postoperative extubation time, postoperative recovery time, etc. The patients were divided into general anesthesia group (A group), general anesthesia combined epidural block group (B group) and general anesthesia combined transversus abdominis block group (C group ).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Anesthesia methods:\u003c/strong\u003e Fasting for 12h and water prohibition for 6 hours were performed before surgery. Vital signs and other tests were improved after patients entered the operating room. Peripheral veins were opened, balanced salt solution was injected, and internal jugular vein and radial artery puncture were performed after intravenous injection of rirenecil 0.04mg/kg and sufentanil 0.1ug/kg, and peripheral blood pressure was monitored. The general anesthesia group was induced and maintained by intravenous anesthesia. Epidural block combined with general anesthesia group: EB catheterization was performed at the 2-3 plane of lumbar spine, 2ml lidocaine was injected, and the pain plane was observed 5min later, and additional drug dosage was added if necessary, and then general intravenous anesthesia was performed after the effect. The transversal block combined with general anesthesia group: Under the guidance of color ultrasound, the transversal block was given 20ug injection of ropivacaine, and general anesthesia was performed after the completion of the transversal block. Observe the changes of blood pressure and heart rate during the operation, and deal with the drastic changes in blood pressure in time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Inclusion criteria:\u003c/strong\u003e 1) patients with indications for laparoscopic resection of rectal cancer, 2) patients aged \u0026ge;50 years, 3) patients with complete postoperative medical records and able to perform postoperative evaluation;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 Exclusion criteria:\u003c/strong\u003e 1) patients with previous disorders of consciousness, such as mental disorders, mental retardation, etc., 2) patients with previous open surgery or laparoscopic surgery ward, 3) patients with more loss of clinical data, 4) patients with obvious immunodeficiency.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.5 Data collection: \u003c/strong\u003eGeneral data of patients were recorded, including patient\u0026apos;s age, gender, preoperative ASA grading, previous medical history, length of hospital stay, anesthesia method, anesthesia time, postoperative extubation time, postoperative recovery time, postoperative pain score, etc. Postoperative complications of patients were recorded, and lymphocyte subsets and inflammatory factor values of patients were dynamically recorded before surgery and the first, third and fifth days after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.5 Data analysis: \u003c/strong\u003eSPSS 19.0 software was used for data analysis, and Grapaphd 8 was used for drawing. Means and standard deviations were used when data were normally distributed, and medians and quartiles were used when data were not normally distributed. Independent sample t test or Mann-Whitney U test was used to compare the data between the two groups according to the results of normality test. Count data were expressed as n (%), X\u003csup\u003e2\u003c/sup\u003e test was used for comparison between groups, Pearson or Spearman correlation test was used for correlation between two continuous variables, continuous dynamic analysis (GEE) was used to analyze continuous dynamic indicators, P\u0026le;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"2. Result","content":"\u003cp\u003e\u003cstrong\u003e2.1 General information of the patients\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 805 patients underwent laparoscopic radical resection of rectal cancer in the Affiliated Huaian Hospital of Nanjing Medical University by searching electronic cases. Through screening, a total of 360 patients with complete data were included in the study. According to different anesthesia methods, they were divided into three groups, with an average of 120 patients in each group, as shown in Figure 1. In this study, there were no differences among the three groups in terms of gender, age, history of hypertension, history of diabetes, history of coronary heart disease, ASA surgical classification, operation time, and anesthesia time, as shown in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable1：baseline of patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eVaribles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eA group（n=120）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eB group（n=120）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eC group（n=120）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e75（62.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e72（60%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e69（57.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eFamale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e45（37.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e48（40%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e51（42.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e65（54.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e63（52.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e70（58.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eCoronary heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e43（35.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e45（37.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e49（40.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e43（35.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e38（31.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e40（33.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eASA grade（I、II级）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e93（77.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e101（（84.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e96（80%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eDuration of anesthesia（h）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.62\u0026plusmn;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.51\u0026plusmn;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.65\u0026plusmn;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eDuration of surgery（h）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.67\u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.54\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e2.74\u0026plusmn;0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eAge（years）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e63.2\u0026plusmn;5.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e65.4\u0026plusmn;6.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e62.7\u0026plusmn;5.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Intraoperative anesthetics and vasoactive drugs consumption\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared with the general anesthesia group and the general anesthesia combined transversus abdominis block group, the consumption of propofol, remifentanil, cisatracurium in the general anesthesia combined epidural block group was less, and the amount of vasoactive drugs during the operation was less. There was no significant difference in the dosage of anesthetic drugs during operation between the general anesthesia group and the general anesthesia combined transversus abdominis block group. There was no significant difference in the dosage of anesthetic drugs during operation and the amount of intraoperative blood loss among the three groups, as shown in Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2：Intraoperative anesthetics and vasoactive drugs consumption\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eVaribles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eA group（n=120）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eB group（n=120）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eC group（n=120）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003ePropofol（mg）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e939.2\u0026plusmn;55.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e833.7\u0026plusmn;52.1ac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e926\u0026plusmn;43.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eRemifentanil（mg）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e622.8\u0026plusmn;36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e552.4\u0026plusmn;34.7ac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e552.4\u0026plusmn;34.7ac\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eDexmedetomidine（ug）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e79.1\u0026plusmn;4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e76.5\u0026plusmn;4.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e78\u0026plusmn;3.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eCisatracurium（mg）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e946.2\u0026plusmn;56.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e843.1\u0026plusmn;54.2ac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e843.1\u0026plusmn;54.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eSevoflurane\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.026\u0026plusmn;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.0238\u0026plusmn;0.0014ac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.026\u0026plusmn;0.0011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eIntraoperative blood loss（ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e54.2\u0026plusmn;6.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e56.1\u0026plusmn;5.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e55.3\u0026plusmn;4.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eVasoactive agents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e18（15%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e9（7.5%）ac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e15（12.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ea represents the p\u0026amp;lt of group A compared with group B; 0.05; c represents the p\u0026amp;lt of group B compared with group C; 0.05\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Adverse reactions of anesthesia\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompared with the general anesthesia group and the general anesthesia combined transverse abdominis block group, the incidence of postoperative shivering in the general anesthesia combined epidural block group was lower. Compared with the patients in the general anesthesia group, the patients in the general anesthesia combined epidural block group and the general anesthesia combined transversus abbess block group had a lower probability of postoperative vomiting and a lower postoperative pain score (VAS score), and there was no difference in the incidence of anesthesia complications such as cough, restlessness, irritability, vision, and postoperative hypotension, as shown in Table 3.\u003c/p\u003e\n\u003cp\u003eTable 3：Adverse reactions of anesthesia\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eVaribles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eA group（n=120）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eB group（n=120）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eC group（n=120）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eCough up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e13（10.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e11（9.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e10(8.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eagitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e23（19.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e18（15%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e24（20%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003efidgety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e24（20%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e21（17.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e26（21.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eVomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e24（20%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e7（5.9%）a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e11（9.2%）b\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eVAS scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6.54+0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e5.43+0.67a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e5.32+0.57b\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative observation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6（5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e4（3.33%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6（5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative chills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e23（19.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6（5%）ac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e18（18%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eWakefulness agent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e17（14.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e15（12.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e20（16.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative hypotension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e36（30%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e41（34.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e39（32.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ea represents the group A compared with group B; p\u0026lt;0.05; c represents the group B compared with group C; p\u0026lt;0.05\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Dynamic comparison of immune function\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were no significant differences in CD3+T, CD4+T, CD4/CD8 and NK cell counts among the three groups before operation. Compared with the general anesthesia group and the general anesthesia combined transversus abdominis block group, the postoperative CD3+T, CD4+T, CD4/CD8 and NK cell counts were higher in the general anesthesia combined epidural block group on the first and third days after surgery (p\u0026lt;0.05). Compared with the general anesthesia group, the CD3+T, CD4+T and NK cell counts of the patients in the general anesthesia combined transverse abdominis block group were higher (p\u0026amp;lt; 0.05). The CD3+T, CD4/CD8 and NK cell counts of patients in general anesthesia combined epidural block group and general anesthesia + transversus abdominis block group were higher than those in general anesthesia group on the 5th day after operation, as shown in Figure 2. The CRP, WBC and IFN-ɑ counts of patients in general anesthesia + epidural block group and general anesthesia combined transversus abdominis block group were lower than those in general anesthesia group on postoperative day 1 and 3. The IL-6 counts of patients in general anesthesia combined epidural block group and general anesthesia combined transversus abdominis block group were lower than those in general anesthesia group on postoperative day 1, 3 and 5. No differences in TNF-\u0026alpha; counts were observed among the three groups at the three time nodes, as shown in Figure 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Postoperative Complications\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompared with the general anesthesia group, the general anesthesia + epidural block group and general anesthesia + transversus abdominis block group had lower proportion of postoperative pain, fewer patients needed postoperative analgesia, and shorter length of hospital stay. There were no differences among the three groups in postoperative complications such as lower extremity deep vein thrombosis, incision infection, and gastrointestinal dysfunction, as shown in Table 4.\u003c/p\u003e\n\u003cp\u003eTable 4：Postoperative Complications\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eVaribles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eA group（n=120）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eB group（n=120）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eC group（n=120）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e28(23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e12(10%)a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e9(7.5%)b\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eDeep vein thrombosis of lower extremity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e13(10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e15(12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e14(11.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eAnalgesic equipment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e20(16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e7(5.8%)a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e5(4.2%)b\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eIncision infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e5(4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6(5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6(5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eGastrointestinal dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6(5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e4(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e4(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative hospital stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e8.76\u0026plusmn;1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6.76\u0026plusmn;0.78a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e7.03\u0026plusmn;0.84b\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;a represents the group A compared with group B,p\u0026lt;0.05; b represents the group A compare with group C,p\u0026lt;0.05;c represents the group B compared with group C; p\u0026lt;0.05\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe incidence of rectal cancer is increasing year by year and has become one of the major abdominal tumors. Laparoscopic radical resection of rectal cancer is the main operation for patients with rectal cancer. In order to improve postoperative quality of life of patients with rectal cancer and reduce perioperative complications, this study was divided into three groups according to different anesthesia methods. A total of 360 patients with complete data who underwent laparoscopic radical resection for rectal cancer in the Department of Anesthesiology, Huaian First People\u0026apos;s Hospital Affiliated to Nanjing Medical University from 2016 to 2021 were included to analyze the effects of different anesthesia methods on stress level, immune damage and postoperative complications.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Immune function impairment and its complications may affect the prognosis of patients with rectal cancer, such as increasing the record of postoperative concurrent infections, resulting in weakness and prolonged hospital stay [11-13]. T lymphocytes play an important role in cellular immunity. CD3+T cells can reduce immune response, transmit immune signals to the body, and reduce the incidence of postoperative infection. CD4+ T lymphocytes mainly play an auxiliary killing role, and can be induced to differentiate into helper T (T helper) cells to participate in immune regulation under the action of various precursors [14, 15], while CD4/CD8 cells show abnormal cytophagocytosis function. Multiple studies have confirmed that the huge stress of surgery, local tissue damage, intestinal flora disorder and pain can lead to increased catecholamine hormone levels, thus activating the \u0026beta;2 adrenergic pathway, reducing the ability of T cells to secrete IFN-r, and reducing the toxic effects of CD8+T cells and NK cells [16、17]. Therefore, The continuous excitation of sympathetic nerve during the operation may be related to the injury of anti-tumor immune function. In this study, compared with patients under general anesthesia and transversal abdominal block, CD3+T, CD4+T, CD4/CD8, and NK cell counts in the general anesthesia + epidural block group on day 1 and day 3 after surgery were higher than those in the general anesthesia and transabdominal block group (p\u0026lt;0.05), compared with the general anesthesia group, CD3+T, CD4+T and NK cell counts were higher in the general anesthesia combined transverse abdominal block group (p\u0026lt;0.05). The number of CD3+T, CD4/CD8, and NK cells in the general anesthesia combined epidural block group and the general anesthesia combined transversal abdominal block group were higher than those in the general anesthesia combined transversal abdominal block group on the 5th day after surgery, indicating that compared with the general anesthesia group and the general anesthesia combined transversal abdominal block group, general anesthesia combined epidural block may help to reduce the damage of immune function during surgery and facilitate the postoperative recovery of patients.\u003c/p\u003e\n\u003cp\u003eThe level of stress response in perioperative period is often closely related to postoperative organ function injury and prognosis [18、19]. Reducing inflammatory response can also improve postoperative hospital stay and survival rate. IL-6 and CRP are relatively objective data reflecting the inflammatory response of the body, and IL-6 can reflect the severity of the disease in a variety of diseases [20-22], as well as the severe reaction of the disease. In this study, the level of IL-6 in the general anesthesia + epidural block group and the general anesthesia + transverse abdominal block group was lower than that in the general anesthesia + transverse abdominal block group at the 1st, 3rd and 5th day after surgery. IFN-a has antiviral, immune regulation and enhanced phagocytosis function of macrophages [23-25]. In a variety of non-viral diseases, the increased amount of IFN-a reflects the over-activation of immune function, which often means poor prognosis . In this study, The levels of IFN-a in the general anesthesia combined epidural block group and the general anesthesia combined transverse abdominal block group were lower than those in the general anesthesia combined transverse abdominal block group at 1, 3 and 5 days after surgery. Therefore, the results of this study suggest that compared with the general anesthesia group, general anesthesia plus epidural block and general anesthesia plus transverse abdominal muscle block can reduce the level of inflammatory response in patients, thereby reducing the level of organ damage and improving the quality of life in patients.\u003c/p\u003e\n\u003cp\u003ePostoperative pain and chronic complications are common in patients with rectal cancer. Postoperative pain may delay the time for patients to get out of bed, leading to the incidence of postoperative lower extremity deep vein thrombosis and wound infection, while chronic pain may also lead to the incidence of postoperative depression and psychiatric problems [26-28]. In this study, compared with the general anesthesia group, the incidence of postoperative pain was lower in the general anesthesia combined epidural block group and the general anesthesia combined transverse abdominal block group, and fewer patients needed postoperative analgesic equipment, which shortened the length of hospital stay. Therefore, both the general anesthesia combined epidural block group and the general anesthesia combined transverse abdominal block group have the advantages of reducing postoperative pain and shortening hospital stay.\u003c/p\u003e\n\u003cp\u003eAt the same time, in terms of anesthesia drug use and anesthesia-related complications, compared with general anesthesia and general anesthesia combined transversal abdominal block group, general anesthesia combined epidural block group can reduce intraoperative anesthesia drug dosage and reduce the incidence of anesthesia-related complications, which is consistent with the results of previous studies on other diseases [29、30].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study also has several limitations. First, as a single-center study, 360 surgical patients with complete data were included in the study, and there were problems of relatively uniform and small data volume. Second, the transversus abdominis block scheme used in this study was mostly TPAB, and RSB was not compared with the transversus abdominis block scheme, so there may be differences between two different abdominis block schemes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCompared with the general anesthesia group and the general anesthesia combined abdominal transversal block group, general anesthesia combined epidural anesthesia can reduce postoperative immunosuppression and reduce the level of inflammation in rectal cancer patients, and the general anesthesia combined epidural anesthesia group can reduce the amount of intraoperative anesthesia drugs and reduce adverse anesthesia reactions. Compared with the general anesthesia group, Both general anesthesia plus epidural block and general anesthesia plus transversal block can reduce the incidence of postoperative pain.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll work was approved by the co-authors.\u0026nbsp;LL\u0026nbsp;and\u0026nbsp;HX\u0026nbsp;made significant contributions to conception and study design.\u0026nbsp;LL、LYG and LM\u0026nbsp;completed data acquisition. \u0026nbsp;LL、LYG and LM\u0026nbsp; \u0026nbsp;performed data analysis and interpretation; \u0026nbsp;LL、LYG and HX\u0026nbsp;have written the draft of the article and critically revised it. No conflicts of interest exist in the submission of this manuscript. I would like to declare on behalf of my co-authors that the work described was original research that has not been published previously and is not under consideration for publication elsewhere, in whole or in part. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNO funding Support the research\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll experiments in this study were carried out in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethical Committee of The Affiliated Huaian No.1 People\u0026apos;s Hospital of Nanjing Medical University. The data used in this study was anonymised before its use and were collected during routine procedures, which did not pose any additional risk to the patients. The requirement for informed consent by individual patients was waived by the Ethical Committee of The Affiliated Huaian No.1 People\u0026apos;s Hospital of Nanjing Medical University given the retrospective nature of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no confict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026apos; for the section.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSung Hyuna,Ferlay Jacques,Siegel Rebecca L et al. 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The association of chronic pain and postoperative delirium: a prospective observational cohort study.[J] .Minerva Anestesiol, 2022, undefined: undefined.\u003c/li\u003e\n\u003cli\u003eHardy Alexandre,Sandiford Marie-H\u0026eacute;l\u0026egrave;ne,Menigaux Christophe et al. Pain catastrophizing and pre-operative psychological state are predictive of chronic pain after joint arthroplasty of the hip, knee or shoulder: results of a prospective, comparative study at one year follow-up.[J] .Int Orthop, 2022, 46: 2461-2469.\u003c/li\u003e\n\u003cli\u003eLi Ya-Wei,Li Huai-Jin,Li Hui-Juan et al. Delirium in Older Patients after Combined Epidural-General Anesthesia or General Anesthesia for Major Surgery: A Randomized Trial.[J] .Anesthesiology, 2021, 135: 218-232.\u003c/li\u003e\n\u003cli\u003eZhang Shaoqiong,Gao Tianqi,Li Yuanyuan et al. Effect of combined epidural-general anesthesia on long-term survival of patients with colorectal cancer: a meta-analysis of cohort studies.[J] .Int J Colorectal Dis, 2022, 37: 725-735.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"rectal cancer, Immunosuppression, Postoperative pain, Inflammatory response","lastPublishedDoi":"10.21203/rs.3.rs-4812035/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4812035/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTo compare the effect of different surgical methods on the prognosis of patients with colon cancer. 360 patients undergoing laparoscopic radical resection of rectal cancer werei ncluded. Patients' general information, hospital moriality and surgical complications were recorded. The immunological indexes and inflammatory factor levels of patients were dynamically recorded before surgery, and at the first, third and fifth days after surgery. Compared with groups A and C, the intraoperative dosage of propofol, remifentanil and cisatracurium in group B was lower (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), the number of vasoactive drug users and the incidence of postoperative chills were lower (p\u0026amp;lt; 0.05), the probability of vomiting was lower in group B and group C; The cell counts of CD3\u0026thinsp;+\u0026thinsp;T, CD4\u0026thinsp;+\u0026thinsp;T, CD4/CD8 and NK in group B were higher than those in group A and C on day 1 and day 3 after surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), the CD3\u0026thinsp;+\u0026thinsp;T, CD4\u0026thinsp;+\u0026thinsp;T and NK cell counts of group C were higher than those of group A on the first and third days after surgery, while the IL-6, CRP, WBC and IFN-a counts of group B and C were lower than those of group A. Groups B and C had lower postoperative pain scores, lower use of postoperative analgesics, and shorter hospital times. General anesthesia combined epidural block can reduce postoperative immunosuppression and inflammatory response in patients with rectal cancer, and reduce intraoperative anesthetic drug dosage and adverse anesthesia reactions.\u003c/p\u003e","manuscriptTitle":"Effects of different anesthesia methods on patients undergoing laparoscopic radical resection of rectal cancer: a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-08 20:03:22","doi":"10.21203/rs.3.rs-4812035/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dd3ac301-df5f-4c61-bf84-53ba63315b32","owner":[],"postedDate":"September 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":36641640,"name":"Biological sciences/Biophysics"},{"id":36641641,"name":"Biological sciences/Biotechnology"},{"id":36641642,"name":"Biological sciences/Neuroscience"},{"id":36641643,"name":"Biological sciences/Physiology"}],"tags":[],"updatedAt":"2025-03-03T07:54:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-08 20:03:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4812035","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4812035","identity":"rs-4812035","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}