Effect of Remimazolam on Cellular Immune Response and Postoperative Recovery in Patients Undergoing Laparoscopic Colorectal Cancer Surgery
-
Jianyan Wu
,
Huijie Ma
,
Boya Zhang
,
Ying Wang
,
Yingui Sun
Abstract
We aimed to evaluate the effect of remimazolam-based general anesthesia on cellular immune function and postoperative recovery quality in patients undergoing laparoscopic radical colorectal cancer surgery.
A total of 90 patients scheduled for elective laparoscopic colorectal cancer radical surgery were randomly divided into 2 groups: the remimazolam group (Group R) and the propofol group (Group P), with 45 patients in each group. Anesthesia induction in Group R involved intravenous remimazolam, and in Group P, intravenous propofol until the loss of consciousness (modified observer’s assessment of alertness/sedation [MOAA/S] score 1–2). Both groups then received intravenous sufentanil and cisatracurium for intubation. Cellular immune function markers (CD3+, CD4+, CD8+ T and natural killer [NK] cells) were recorded at different time points. Quality of Recovery [QoR]-15 scale scores, hemodynamic parameters, sedation scores (Riker and Ramsay scales), recovery times and adverse events were also recorded.
Compared to Group P, Group R had significantly higher NK, CD3+, and CD4+ cell levels immediately after surgery and at 24 hours postoperatively. Group R showed a significantly lower incidence of intraoperative hypotension, bradycardia, and vasopressor use. Additionally, QoR-15 scores at 24 and 72 hours were higher in Group R. There were no significant differences in Riker or Ramsay scores, extubation time, post-anesthesia care unit stay, or the incidence of postoperative nausea, vomiting, and drowsiness between the 2 groups.
Compared with propofol, remimazolam anesthesia results in better perioperative immune function preservation, reduced intraoperative hypotension and bradycardia, and improved postoperative recovery quality in patients undergoing laparoscopic radical colorectal cancer surgery.
1. Baidoun F, Elshiwy K, Elkeraie Y, Merjaneh Z, Khoudari G, Sarmini MT, et al. Colorectal Cancer Epidemiology: Recent Trends and Impact on Outcomes. Curr Drug Targets. 2021;22(9):998-1009.
2. Patel SG, Karlitz JJ, Yen T, Lieu CH, Boland CR. The rising tide of early-onset colorectal cancer: a comprehensive review of epidemiology, clinical features, biology, risk factors, prevention, and early detection. Lancet Gastroenterol. 2022;7(3):262-74.
3. Li N, Lu B, Luo C, Cai J, Lu M, Zhang Y, et al. Incidence, mortality, survival, risk factor and screening of colorectal cancer: A comparison among China, Europe, and northern America. Cancer Lett. 2021;522:255-68.
4. Mahmoud NN. Colorectal Cancer: Preoperative Evaluation and Staging. Surg Oncol Clin N Am. 2022;31(2):127-41.
5. Tsalikidis C, Mitsala A, Mentonis VI, Romanidis K, Pappas-Gogos G, Tsaroucha AK, et al. Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going? Curr Oncol. 2023;30(3):3111-37.
6. Willemsen P, Devriendt S, Heyman S, Van Fraeyenhove F, Perkisas S. Colorectal cancer surgery in octogenarians: real-world long-term results. Langenbeck Arch Surg. 2023;409(1):13.
7. Wang Y, Sun Y, Hu Y, Xiao Z. Bibliometric Analysis of Anesthetic Drugs' Effects on Immune Function- Current Knowledge, Hotspots and Future Perspectives. Drug Des Devel Ther. 2023;17(5):3219-30.
8. Liao YQ, Min J, Wu ZX, Hu Z. Comparison of the effects of remimazolam and dexmedetomidine on early postoperative cognitive function in elderly patients with gastric cancer. Front Aging Neurosci. 2023;15(12):1123089.
9. Huang Y, Yan T, Lu G, Luo H, Lai Z, Zhang L. Efficacy and safety of remimazolam compared with propofol in hypertensive patients undergoing breast cancer surgery: a single-center, randomized, controlled study. Bmc Anesthesiol. 2023;23(1):409.
10. Barbosa EC, Espirito SP, Baraldo S, Meine GC. Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis. Brit J Anaesth. 2024;132(6):1219-29.
11. Hu Q, Liu X, Wen C, Li D, Lei X. Remimazolam: An Updated Review of a New Sedative and Anaesthetic. Drug Des Devel Ther. 2022;16:3957-74.
12. Choi JY, Lee HS, Kim JY, Han DW, Yang JY, Kim MJ, et al. Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery: A randomized non-inferiority trial. J Clin Anesth. 2022;82:110955.
13. Dai G, Pei L, Duan F, Liao M, Zhang Y, Zhu M, et al. Safety and efficacy of remimazolam compared with propofol in induction of general anesthesia. Minerva Anestesiol. 2021;87(10):1073-9.
14. Chang Y, Huang YT, Chi KY, Huang YT. Remimazolam versus propofol for procedural sedation: a meta-analysis of randomized controlled trials. Peerj. 2023;11:e15495.
15. Zhang J, Cairen Z, Shi L, Pang S, Shao Y, Wang Y, et al. Remimazolam versus propofol for procedural sedation and anesthesia: a systemic review and meta-analysis. Minerva Anestesiol. 2022;88(12):1035-42.
16. Jeon YG, Kim S, Park JH, Lee J, Song SA, Lim HK, et al. Incidence of intraoperative hypotension in older patients undergoing total intravenous anesthesia by remimazolam versus propofol: A randomized controlled trial. Medicine. 2023;102(49):e36440.
17. Schramm S, Haddad AF, Chyall L, Krieg SM, Sollmann N, Tarapore PE. Navigated TMS in the ICU: Introducing Motor Mapping to the Critical Care Setting. Brain Sci. 2020;10(12)
18. Freuchet A, Roy P, Armstrong SS, Oliaeimotlagh M, Kumar S, Orecchioni M, et al. Identification of human exT(reg) cells as CD16(+)CD56(+) cytotoxic CD4(+) T cells. Nat Immunol. 2023;24(10):1748-61.
19. Dolina JS, Van Braeckel-Budimir N, Thomas GD, Salek-Ardakani S. CD8(+) T Cell Exhaustion in Cancer. Front Immunol. 2021;12(3):715234.
20. Zheng Z, Wieder T, Mauerer B, Schafer L, Kesselring R, Braumuller H. T Cells in Colorectal Cancer: Unravelling the Function of Different T Cell Subsets in the Tumor Microenvironment. Int J Mol Sci. 2023;24(14)
21. Reina-Campos M, Scharping NE, Goldrath AW. CD8(+) T cell metabolism in infection and cancer. Nat Rev Immunol. 2021;21(11):718-38.
22. Xie G, Dong H, Liang Y, Ham JD, Rizwan R, Chen J. CAR-NK cells: A promising cellular immunotherapy for cancer. Ebiomedicine. 2020;59:102975.
23. Shimasaki N, Jain A, Campana D. NK cells for cancer immunotherapy. Nat Rev Drug Discov. 2020;19(3):200-18.
24. Kyrysyuk O, Wucherpfennig KW. Designing Cancer Immunotherapies That Engage T Cells and NK Cells. Annu Rev Immunol. 2023;41:17-38.
25. Konstantis G, Tsaousi G, Kitsikidou E, Zacharoulis D, Pourzitaki C. The Immunomodulatory Effect of Various Anaesthetic Practices in Patients Undergoing Gastric or Colon Cancer Surgery: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Clin Med. 2023;12(18)
26. Gao J, Ding C, Zhou J, Wu G, Han Z, Li J, et al. Propofol suppresses lung cancer tumorigenesis by modulating the circ-ERBB2/miR-7-5p/FOXM1 axis. Thorac Cancer. 2021;12(6):824-34.
27. Xian XS, Wang YT, Jiang XM. Propofol Inhibits Proliferation and Invasion of Stomach Cancer Cells by Regulating miR-205/YAP1 Axis. Cancer Manag Res. 2020;12(1):10771-9.
28. Lee J, Kim DH, Ju JW, Nam K, Cho YJ, Jeon Y, et al. Comparison of recovery profiles between total intravenous anaesthesia with propofol or remimazolam reversed with flumazenil in patients undergoing breast surgery: A randomised controlled trial. Eur J Anaesth. 2024;41(3):199-207.
29. Myles PS, Shulman MA, Reilly J, Kasza J, Romero L. Measurement of quality of recovery after surgery using the 15-item quality of recovery scale: a systematic review and meta-analysis. Brit J Anaesth. 2022;128(6):1029-39.
30. Myles PS, Myles DB. An Updated Minimal Clinically Important Difference for the QoR-15 Scale. Anesthesiology. 2021;135(5):934-5.
31. Shinji S, Yamada T, Matsuda A, Sonoda H, Ohta R, Iwai T, et al. Recent Advances in the Treatment of Colorectal Cancer: A Review. J Nippon Med Sch. 2022;89(3):246-54.
32. Becattini C, Pace U, Pirozzi F, Donini A, Avruscio G, Rondelli F, et al. Rivaroxaban vs placebo for extended antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer. Blood. 2022;140(8):900-8.
33. Liu T, Zhao H, Zhao X, Qu M. Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer: A Single-Center Prospective Randomized Controlled Study. Med Sci Monitor. 2024;30:e943784.
34. Tang L, Sun Y, Hao X, Sun X, Xie C, Wang T, et al. Effect of general anaesthesia with remimazolam versus propofol on postoperative quality of recovery in patients undergoing ambulatory arthroscopic meniscus repair: a randomised clinical trial. BJA Open. 2023;8(3):100237.
2. Patel SG, Karlitz JJ, Yen T, Lieu CH, Boland CR. The rising tide of early-onset colorectal cancer: a comprehensive review of epidemiology, clinical features, biology, risk factors, prevention, and early detection. Lancet Gastroenterol. 2022;7(3):262-74.
3. Li N, Lu B, Luo C, Cai J, Lu M, Zhang Y, et al. Incidence, mortality, survival, risk factor and screening of colorectal cancer: A comparison among China, Europe, and northern America. Cancer Lett. 2021;522:255-68.
4. Mahmoud NN. Colorectal Cancer: Preoperative Evaluation and Staging. Surg Oncol Clin N Am. 2022;31(2):127-41.
5. Tsalikidis C, Mitsala A, Mentonis VI, Romanidis K, Pappas-Gogos G, Tsaroucha AK, et al. Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going? Curr Oncol. 2023;30(3):3111-37.
6. Willemsen P, Devriendt S, Heyman S, Van Fraeyenhove F, Perkisas S. Colorectal cancer surgery in octogenarians: real-world long-term results. Langenbeck Arch Surg. 2023;409(1):13.
7. Wang Y, Sun Y, Hu Y, Xiao Z. Bibliometric Analysis of Anesthetic Drugs' Effects on Immune Function- Current Knowledge, Hotspots and Future Perspectives. Drug Des Devel Ther. 2023;17(5):3219-30.
8. Liao YQ, Min J, Wu ZX, Hu Z. Comparison of the effects of remimazolam and dexmedetomidine on early postoperative cognitive function in elderly patients with gastric cancer. Front Aging Neurosci. 2023;15(12):1123089.
9. Huang Y, Yan T, Lu G, Luo H, Lai Z, Zhang L. Efficacy and safety of remimazolam compared with propofol in hypertensive patients undergoing breast cancer surgery: a single-center, randomized, controlled study. Bmc Anesthesiol. 2023;23(1):409.
10. Barbosa EC, Espirito SP, Baraldo S, Meine GC. Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis. Brit J Anaesth. 2024;132(6):1219-29.
11. Hu Q, Liu X, Wen C, Li D, Lei X. Remimazolam: An Updated Review of a New Sedative and Anaesthetic. Drug Des Devel Ther. 2022;16:3957-74.
12. Choi JY, Lee HS, Kim JY, Han DW, Yang JY, Kim MJ, et al. Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery: A randomized non-inferiority trial. J Clin Anesth. 2022;82:110955.
13. Dai G, Pei L, Duan F, Liao M, Zhang Y, Zhu M, et al. Safety and efficacy of remimazolam compared with propofol in induction of general anesthesia. Minerva Anestesiol. 2021;87(10):1073-9.
14. Chang Y, Huang YT, Chi KY, Huang YT. Remimazolam versus propofol for procedural sedation: a meta-analysis of randomized controlled trials. Peerj. 2023;11:e15495.
15. Zhang J, Cairen Z, Shi L, Pang S, Shao Y, Wang Y, et al. Remimazolam versus propofol for procedural sedation and anesthesia: a systemic review and meta-analysis. Minerva Anestesiol. 2022;88(12):1035-42.
16. Jeon YG, Kim S, Park JH, Lee J, Song SA, Lim HK, et al. Incidence of intraoperative hypotension in older patients undergoing total intravenous anesthesia by remimazolam versus propofol: A randomized controlled trial. Medicine. 2023;102(49):e36440.
17. Schramm S, Haddad AF, Chyall L, Krieg SM, Sollmann N, Tarapore PE. Navigated TMS in the ICU: Introducing Motor Mapping to the Critical Care Setting. Brain Sci. 2020;10(12)
18. Freuchet A, Roy P, Armstrong SS, Oliaeimotlagh M, Kumar S, Orecchioni M, et al. Identification of human exT(reg) cells as CD16(+)CD56(+) cytotoxic CD4(+) T cells. Nat Immunol. 2023;24(10):1748-61.
19. Dolina JS, Van Braeckel-Budimir N, Thomas GD, Salek-Ardakani S. CD8(+) T Cell Exhaustion in Cancer. Front Immunol. 2021;12(3):715234.
20. Zheng Z, Wieder T, Mauerer B, Schafer L, Kesselring R, Braumuller H. T Cells in Colorectal Cancer: Unravelling the Function of Different T Cell Subsets in the Tumor Microenvironment. Int J Mol Sci. 2023;24(14)
21. Reina-Campos M, Scharping NE, Goldrath AW. CD8(+) T cell metabolism in infection and cancer. Nat Rev Immunol. 2021;21(11):718-38.
22. Xie G, Dong H, Liang Y, Ham JD, Rizwan R, Chen J. CAR-NK cells: A promising cellular immunotherapy for cancer. Ebiomedicine. 2020;59:102975.
23. Shimasaki N, Jain A, Campana D. NK cells for cancer immunotherapy. Nat Rev Drug Discov. 2020;19(3):200-18.
24. Kyrysyuk O, Wucherpfennig KW. Designing Cancer Immunotherapies That Engage T Cells and NK Cells. Annu Rev Immunol. 2023;41:17-38.
25. Konstantis G, Tsaousi G, Kitsikidou E, Zacharoulis D, Pourzitaki C. The Immunomodulatory Effect of Various Anaesthetic Practices in Patients Undergoing Gastric or Colon Cancer Surgery: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Clin Med. 2023;12(18)
26. Gao J, Ding C, Zhou J, Wu G, Han Z, Li J, et al. Propofol suppresses lung cancer tumorigenesis by modulating the circ-ERBB2/miR-7-5p/FOXM1 axis. Thorac Cancer. 2021;12(6):824-34.
27. Xian XS, Wang YT, Jiang XM. Propofol Inhibits Proliferation and Invasion of Stomach Cancer Cells by Regulating miR-205/YAP1 Axis. Cancer Manag Res. 2020;12(1):10771-9.
28. Lee J, Kim DH, Ju JW, Nam K, Cho YJ, Jeon Y, et al. Comparison of recovery profiles between total intravenous anaesthesia with propofol or remimazolam reversed with flumazenil in patients undergoing breast surgery: A randomised controlled trial. Eur J Anaesth. 2024;41(3):199-207.
29. Myles PS, Shulman MA, Reilly J, Kasza J, Romero L. Measurement of quality of recovery after surgery using the 15-item quality of recovery scale: a systematic review and meta-analysis. Brit J Anaesth. 2022;128(6):1029-39.
30. Myles PS, Myles DB. An Updated Minimal Clinically Important Difference for the QoR-15 Scale. Anesthesiology. 2021;135(5):934-5.
31. Shinji S, Yamada T, Matsuda A, Sonoda H, Ohta R, Iwai T, et al. Recent Advances in the Treatment of Colorectal Cancer: A Review. J Nippon Med Sch. 2022;89(3):246-54.
32. Becattini C, Pace U, Pirozzi F, Donini A, Avruscio G, Rondelli F, et al. Rivaroxaban vs placebo for extended antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer. Blood. 2022;140(8):900-8.
33. Liu T, Zhao H, Zhao X, Qu M. Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer: A Single-Center Prospective Randomized Controlled Study. Med Sci Monitor. 2024;30:e943784.
34. Tang L, Sun Y, Hao X, Sun X, Xie C, Wang T, et al. Effect of general anaesthesia with remimazolam versus propofol on postoperative quality of recovery in patients undergoing ambulatory arthroscopic meniscus repair: a randomised clinical trial. BJA Open. 2023;8(3):100237.
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| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| Cellular immune function Colorectal cancer surgery General anesthesia Natural killer cells Postoperative recovery Remimazolam | ||
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How to Cite
1.
Wu J, Ma H, Zhang B, Wang Y, Sun Y. Effect of Remimazolam on Cellular Immune Response and Postoperative Recovery in Patients Undergoing Laparoscopic Colorectal Cancer Surgery. Iran J Allergy Asthma Immunol. 2025;:1-11.
