Effects of Analgesic Adequacy on Perioperative Immune Function and Tumor Microenvironment in Patients Undergoing Gynecological Laparoscopic Malignant Tumor Surgery
Objective: To evaluate the effects of adequate perioperative analgesia on immune function, stress-inflammatory responses, tumor microenvironment-related biomarkers, and early recovery after laparoscopic surgery for gynecological malignancies. Methods: This prospective study enrolled 116 patients who underwent laparoscopic surgery between June 2023 and November 2024. Patients were randomly assigned to an adequate analgesia group or a conventional analgesia group, with 58 patients in each group. Conventional analgesia was administered on demand, whereas adequate analgesia involved preventive, multimodal, and dynamically adjusted management. Pain scores, rescue analgesia, immune parameters, stress-inflammatory factors, tumor-related biomarkers, and recovery outcomes were compared. Results: Numerical rating scale scores at 6, 24, 48, and 72 h were significantly lower in the adequate analgesia group, and the rescue analgesia rate decreased from 50.0% to 15.5% (all P < 0.001). Patients receiving adequate analgesia had higher postoperative CD3⁺ and CD4⁺ T-cell proportions, CD4⁺/CD8⁺ ratios, natural killer cell activity, IgA, and IgG levels, together with lower CD8⁺ T-cell proportions. Cortisol, norepinephrine, interleukin-6, C-reactive protein, vascular endothelial growth factor, matrix metalloproteinase-9, and transforming growth factor-β levels were also significantly lower. Moreover, adequate analgesia shortened the time to first ambulation and hospital stay and reduced postoperative adverse events. Conclusion: Adequate perioperative analgesia may attenuate stress-inflammatory responses and transient immunosuppression, improve circulating tumor microenvironment-related biomarker profiles, and promote early recovery after laparoscopic surgery for gynecological malignancies.
[1] Reysner T, Reysner M, 2026, Regional Anesthesia and the Perioperative Inflammatory Window in Cancer Surgery: From Surgical Stress to Immunometabolic Reprogramming. Cancers (Basel), 7: 1158.
[2] Guo R, Yang W, Zhong M, et al., 2024, The Relationship Between Anesthesia, Surgery and Postoperative Immune Function in Cancer Patients: A Review. Front Immunol, 1441020.
[3] Bezu L, Akcal O, Bell M, et al., 2024, Perioperative Immunosuppressive Factors During Cancer Surgery: An Updated Review. Cancers (Basel), 13: 2304.
[4] Teng Y, Yin Y, Shi Y, et al., 2025, The Impact of Perioperative Anesthesia Management-Induced Immunosuppression on Postoperative Cancer Recurrence and Metastasis: A Narrative Review. Front Oncol, 1558652.
[5] Xia S, Zhou D, Ge F, et al., 2023, Influence of Perioperative Anesthesia on Cancer Recurrence: From Basic Science to Clinical Practice. Curr Oncol Rep, 63–81.
[6] Takeyama E, Miyo M, Matsumoto H, et al., 2021, Long-Term Survival Differences Between Sevoflurane and Propofol Use in General Anesthesia for Gynecologic Cancer Surgery. J Anesth, 495–504.
[7] Shaji S, Smith C, Forget P, 2021, Perioperative NSAIDs and Long-Term Outcomes After Cancer Surgery: A Systematic Review and Meta-Analysis. Curr Oncol Rep, 146.
[8] Abdelaatti A, Buggy D, Wall T, 2024, Local Anaesthetics and Chemotherapeutic Agents: A Systematic Review of Preclinical Evidence of Interactions and Cancer Biology. BJA Open, 100284.
[9] Ailioaie R, Stefanescu E, Leahu C, et al., 2024, The Influence of Analgesic Wound Infiltration on Postoperative Pain and Inflammatory Cytokines in Open Colorectal Surgery: A Randomized Comparative Pilot Study. Medicina (Kaunas), 8: 1244.
[10] Cho J, Kim N, Shim J, et al., 2021, The Immunomodulatory Effect of Ketamine in Colorectal Cancer Surgery: A Randomized-Controlled Trial. Can J Anaesth, 683–692.
[11] Cho J, Seon K, Kim M, et al., 2021, Effects of Perioperative Dexmedetomidine on Immunomodulation in Uterine Cancer Surgery: A Randomized, Controlled Trial. Front Oncol, 749003.
[12] Shin S, Kim K, Hwang H, et al., 2021, Immunomodulatory Effects of Perioperative Dexmedetomidine in Ovarian Cancer: An In Vitro and Xenograft Mouse Model Study. Front Oncol, 722743.
[13] Geng Z, Bi H, Zhang D, et al., 2021, The Impact of Multimodal Analgesia-Based Enhanced Recovery Protocol on Quality of Recovery After Laparoscopic Gynecological Surgery: A Randomized Controlled Trial. BMC Anesthesiol, 179.
[14] Zhang Y, Lu J, Qin M, et al., 2023, Effects of Different Anesthesia Methods on Postoperative Immune Function in Patients Undergoing Gastrointestinal Tumor Resection. Sci Rep, 243.
[15] Hashemian M, Sahebdad-Khabisi S, Honarvar Z, et al., 2025, Effects of Spinal Versus General Anesthesia on Serum Oxidative Stress Markers and Cytokine Release After Abdominal Hysterectomy: A Non-Randomized Trial. Sci Rep, 30247.
[16] Bain C, Myles P, Corcoran T, et al., 2023, Postoperative Systemic Inflammatory Dysregulation and Corticosteroids: A Narrative Review. Anaesthesia, 356–370.
[17] Maowulieti G, Zhao S, Zhao M, et al., 2023, The Role of Inflammatory Factors and T-Cell Subsets in the Diagnosis of Recurrence in Epithelial Ovarian Cancer Patients and the Effect of Olaparin Treatment on Them. Immun Inflamm Dis, 10: e1059.
[18] Shen H, Pang Q, Gao Y, et al., 2023, Effects of Epidural Anesthesia on the Prognosis of Ovarian Cancer: A Systematic Review and Meta-Analysis. BMC Anesthesiol, 390.
