Propofol-based versus volatile anesthesia and postoperative immune response in prostate cancer

Prostate cancer ranks among the most prevalent malignancies in men globally. Radical prostatectomy remains a cornerstone treatment for patients with localized or selected locally advanced disease. Perioperative surgical stress and anesthetic intervention can trigger significant immune and inflammatory responses. Early postoperative immune suppression is recognized as a key biological process influencing recovery trajectories and subsequent treatment tolerance. However, robust and targeted clinical evidence regarding the impact of different anesthetic maintenance techniques on postoperative immune response in prostate cancer patients remains limited. This study aimed to compare the effects of propofol-based total intravenous anesthesia (TIVA) versus volatile anesthesia on early postoperative immune responses following radical robot-assisted prostatectomy for prostate cancer and to explore its potential clinical implications.

This single-center retrospective cohort study included patients with prostate cancer undergoing elective radical robot-assisted prostatectomy between January 1, 2023 and December 31, 2025. Patients were categorized into two groups based on the primary anesthetic maintenance technique: propofol-based TIVA and volatile anesthesia. The follow-up period spanned from the day of surgery (anesthesia induction) until completion of predetermined immune marker monitoring, covering the perioperative and early postoperative hospitalization phase. The primary outcome was the change in absolute peripheral blood lymphocyte count from preoperative baseline to postoperative day (POD) 1 [change in absolute lymphocyte count (ΔALC)]. Secondary outcomes included the absolute neutrophil count (ANC), total white blood cell count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP) level on POD1. For a subset of patients, dynamic changes in immune markers on PODs 3 and 7 were further analyzed. Propensity score (PS) methods were employed to balance baseline differences. Associations between anesthetic technique and immune markers were assessed using multivariable linear regression and linear mixed-effects models.

A total of 121 patients were included (TIVA group: n=62; volatile anesthesia group: n=59). After PS adjustment, compared to the volatile anesthesia group, the TIVA group exhibited a significantly higher absolute peripheral blood lymphocyte count on POD1, alongside significantly lower ANCs, NLR, and CRP levels. Longitudinal analysis indicated a gradual recovery of lymphocyte counts over time, with a faster recovery rate observed in the TIVA group. These findings remained consistent across different PS adjustment strategies and multiple sensitivity analyses.

In patients undergoing radical robot-assisted prostatectomy for prostate cancer, propofol-based TIVA was associated with a relatively attenuated degree of early postoperative immune suppression and a reduced magnitude of inflammatory response. The results suggest that the choice of anesthetic maintenance technique may participate in modulating postoperative physiological responses through its effects on perioperative immune function. Prospective, multicenter studies are warranted to further validate the clinical translational significance of these immunological differences. It is important to note that these findings are based on surrogate immune markers; their direct relationship with clinical outcomes such as postoperative complications or long-term oncologic prognosis remains to be established.