The effect on in vivo cellular immunity of anesthesia and operation was evaluated in 250 cancer patients who received sensitizing doses of dinitrochlorobenzene (DNCB). The primary immune response to DNCB of 218 patients who completed the 2-week sensitization period prior to operation was compared with that of 32 patients who had interruption of the sensitization period by general anesthesia or operation. The extent and histologic types of malignances were similar in the two groups; however, 53% of patients who had interruption of sensitization by anesthesia or operation were anergic to DNCB, while only 9% of patients with an uninterrupted sensitization period were anergic (P < 0.001). Similarly, in patients who responded to DNCB, there was an increased incidence of impaired responses in the group who had interruption of the sensitization period. These findings extend previous demonstrations of an immunosuppressive effect of anesthesia and operation as assayed by in vitro correlates of cellular immunity and in vivo response to recall antigens. The results indicate that correlations between primary immune responses to DNCB of tumor-bearing patients and prognosis after treatment may be invalid if the sensitization period is interrupted by anesthesia or operation. Because of the possible facilitation of the dissemination, implantation, and propagation of tumor cells during a period of suppressed cellular immunity related to anesthesia and operation, these results suggest the need for investigating the desirability and means of maintaining and even augmenting cellular immune competence in cancer patients during anesthesia and operation.
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