The present findings show that there wasn’t a significant difference in the neutrophil, lymphocyte, and platelet counts, or the NLR and PLR between the presurgery and 1 h postsurgery in both anesthesia groups.
Yamanaka et al.  reported that patients who have gastric cancer with a NLR <2.56 were SIR negative and those with a NLR ≥2.56 were SIR positive. They also reported that the NLR ratio is an independent prognostic factor in patients with advanced-stage gastric cancer. Measurement of the NLR might serve as a clinically accessible and useful biomarker of patient survival. In the present study 1 h postsurgery the NLR was <2.56 in both anesthesia groups, indicating that SIR was not present.
Smith et al.  reported that patients who have periampullary malignancy with a PLR <150 were SIR negative and those with a PLR ≥150 were SIR positive. They further reported that the preoperative PLR are indicators of tumor invasiveness and the requirement for laparoscopic staging in patients with potentially resectable periampullary malignancy. When they combined the requirement for both the CA19-9 level ≤ 150kU/l and PLR to be ≤150 (38 out of 183), both the positive predictive value (95%) and specificity (96%) improved (Fisher’s exact test P = 0.065 and P <0.001, respectively); 21% of laparoscopies were avoidable when using these criteria. In the present study the PLR was <150 in both groups in preoperatively and postoperatively.
Some researchers have investigated the effect of regional anesthesia on SIR and postoperative complications. Bedirli et al.  investigated the effect of thoracic epidural anesthesia (TEA) on SIR and consequent postoperative lung complications in rats, reporting that TEA reduces SIR by reducing plasma TNF-α, IL-6, and IL-1β concentrations, which prevents postoperative pulmonary complications. These effects are due to a decrease in apoptosis, ICAM-1 release and proinflammatory cytokine release, and an increase in antioxidant enzyme activity. The researchers posited that these effects are not due to sympathetic block, but may be due to the systemic effect of bupivacaine. In the present study there weren’t any postsurgery changes in SIR parameters in the Group 1 patients given bupivacaine.
Researchers have sought to determine if the effects of general and regional anesthesia on SIR differ. One such study included 40 patients that underwent total knee arthroplasty . SIR parameters IL-6, IL-8, and IL-1β, TNF-α, and C-reactive protein (CRP) were measured before induction, immediately after surgery, and 24 h postsurgery. In both the general and regional anesthesia groups IL-6 and CRP increased significantly at 24 h postsurgery, as compared to presurgery. As noted in the present study, the effect of general and regional anesthesia on SIR did not differ; however, the present study used the NLR and PLR as SIR parameters.
Measurement of the NLR and PLR are both readily available and inexpensive methods for investigating SIR. Solakhan et al.  investigated the relationship between SIR, and tumor histology and pathogenesis in patients that underwent TUR-B surgery for bladder tumors. They observed that the NLR and PLR can be used as SIR parameters. The platelet count can increase in patients with solid tumors as a result of the inflammatory response. The IL-6 thrombopoietic cytokine can be released by tumor cells. Platelets can facilitate metastasis by protecting tumors from NK cell lysis and, in association with the biological factors involved, can also contribute to tumor growth, invasion, and angiogenesis. The prognosis and surveillance of many cancers such as colorectal, ovarian, lung, and hepatocellular cancer are related to PLR (13,14); yet, the mechanism is not specific. Platelets can enhance tumor growth by stimulating angiogenesis via vascular endothelial factor (VEGF) . An increase in the preoperative NLR is associated with advanced stage in non-small cell lung cancer patients, but is an independent indicator of survival following complete resection . The NLR is a potential biological marker of high risk of mortality in stage I patients.
The NLR and PLR are used as prognostic markers in many types of cancer surgery, as well as for preoperative surgical staging. Ertas et al.  noted a higher NLR and PLR in gynecological cancer patients with lymph node involvement than the patients without lymph node involvement. Expert that the NLR is superior to the PLR in terms of sensitivity and specificity. Again, they proved the connection between tumor size and the NLR. The present study included patients with bladder cancer of similar pathogenesis based on the assumption that patients with bladder cancer of varying pathogenesis may have SIR parameters that differ.
Mano et al.  posited that the NLR could play a role in predicting recurrence in patients with bladder tumors. They found that the recurrence rate was higher in the patients with a high NLR ratio. The present study aimed to determine which anesthesia technique (general versus regional) affects the NLR the least.
In addition, the effects of anesthesia types on SIR and tumor prognosis like surgical types are investigated. The effects of TIVA (total intravenous anesthesia) and volatile anesthetics on postoperative SIR, postoperative complications, and duration of hospitalization were studied in patients that underwent surgery for pancreatic cancer. During the 90-d postoperative follow-up period fewer postoperative complications were observed in the patients that underwent TIVA, although preoperative and postoperative NLR and PLR values did not differ between the 2 groups .
Kim et al.  studied the effect of TIVA and sevoflurane volatile anesthesia on preoperative and postoperative NLR and PLR in 40 patients that underwent endoscopic vaginal hysterectomy. The total leukocyte count, neutrophil count, and NLR significantly increased, and the lymphocyte count significantly decreased in both groups immediately after surgery, 2 h postsurgery, and 24 h postsurgery. The neutrophil count and NLR were lower in the TIVA group. Their findings show that TIVA has less of an effect on SIR than sevoflurane anesthesia. In the present study there weren’t any differences in the SIR parameters at 1 h postsurgery between the 2 anesthesia groups. A study on the effect of paravertebral block + propofol versus inhalation anesthesia + opioid use on the postoperative NLR was compared in patients that underwent surgery for breast cancer . The preoperative NLR was similar in both groups, but the postoperative NLR was lower in the paravertebral block + propofol group (mean: 3.0 [range: 2.4-4.2] vs. mean: 4.0 [range: 2.9-5.4], P = 0.001). Propofol-paravertebral anesthesia attenuated the postoperative increase in the NLR, but the effect was not significant. In the present study the NLR was lower in the general anesthesia group at 1 h postsurgery, whereas in the regional anesthesia group it did not change, but the difference was not significant. It was also observed that the PLR was lower postsurgery as compared to presurgery in both anesthesia groups.