Outcomes of postoperative preemptive sedation in the intensive care unit for geriatric patients with gastric cancer undergoing gastrectomy

Sep 29, 2026

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Strategic postoperative sedation was evaluated to improve outcomes after open radical gastrectomy in elderly gastric cancer patients at high risk for complications and surgical mortality. A cohort of 324 patients aged over 75 years from 2006–2020 was compared between a preemptive light-sedation ICU approach with prolonged ventilatory assistance for five days and a control strategy using early extubation plus analgesia without postoperative sedatives. Sedation lowered overall postoperative complication rates and reduced pulmonary events, while mortality and length of stay remained unchanged; in vitro testing also showed reduced TNF-α production after propofol or dexmedetomidine.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Abstract

1. INTRODUCTION

Aging context in Taiwan

Lay Summary

J Chin MedAssoc Original article Outcomes of postoperative preemptive sedation in the intensive care unit for geriatric patients with gastric cancer undergoing gastrectomy Wei-Ting Kuoa,b, Chen-Yuan Hsiaoc,d,e, Shu-Cheng Choua,f, Ching-Shu Chiangf,g, Tien-Hua Chenf,h,i, Chi-Hung Lina,j,k,l,*, Pei-Jiun Tsaih,i,m,* aInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; bDepartment of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC; cDivision of Cardiovascular Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan, ROC; dDepartment of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; eTaipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC; fDivision of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; gGraduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; hInstitute of Anatomy and Cell Biology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; iTrauma Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; jInstitute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; kDepartment of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC; lCancer Progression Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; mDepartment of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Abstract Background: Gastric cancer is a common malignancy worldwide, especially in East Asia. However, increasing age is an independent risk factor associated with high operative complications and surgical mortality in radical gastrectomy. To improve the prognosis of surgery, we proposed strategic postoperative sedation for geriatric patients with gastric cancer undergoing radical gastrectomy. Methods: A total of 324 gastric cancer patients, more than 75 years of age who underwent open radical gastrectomy at Taipei Veterans General Hospital between 2006 and 2020 were enrolled. The patients were classified into the sedation group (preemptive light sedation with prolonged mechanical ventilation assistance for the first five days postoperatively in the intensive care unit, n = 53) and the control group (early extubation, received morphine for pain control but no postoperative sedatives in the ordinary ward, n = 271) . We compared the two groups’ baseline clinical characteristics and the associated surgical outcome. We also conducted an in vitro cell experiment with RAW 264.7 macrophage cell line and evaluated the cell performance in various concentrations of sedation drug propofol and dexmedetomidine. Results: Patients in the sedation group has significantly lower postoperative complication rates (13 .7% vs 29.9%; p = 0.031) . Among overall postoperative complications, the incidence rate of pulmonary events was significantly lower in the sedation group. Moreover, the incidence of other complications, including cardiac events, intra-abdominal abscesses, anastomotic leakage, adynamic ileus, and wound infection, was slightly higher in the matched control group without a statistically significant difference. Regarding surgical mortality rate and postoperative hospital length of stay (LOS), there were no significant differences between the two groups. For in vitro cell experiments with RAW 264.7 macrophage cell line, propofol, or dexmedetomidine significantly decreased tumor necrosis factor (TNF)-α production. Conclusion: For elderly patients with gastric cancer who undergo open radical gastrectomy, strategic postoperative sedation is safe and may reduce the incidence of pulmonary complications without prolonging hospital LOS. Keywords: Gastrectomy; Gastric cancer; Intensive care unit; Postoperative

FAQs

What population and procedure were studied in this research?

The study enrolled 324 gastric cancer patients aged over 75 years who underwent open radical gastrectomy at Taipei Veterans General Hospital between 2006 and 2020.

How did the sedation group differ from the control group?

The sedation group received preemptive light sedation with prolonged mechanical ventilation assistance for the first five postoperative days in the ICU, while the control group had early extubation and received morphine for pain control but no postoperative sedatives in the ordinary ward.

What were the main outcomes of postoperative preemptive sedation?

Sedation significantly reduced postoperative complication rates, with a notable decrease in pulmonary events, without increasing surgical mortality or postoperative hospital length of stay; lab experiments showed decreased TNF-α production with propofol or dexmedetomidine.

Sep 29, 2026

Uploaded by Himbo