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

Abstract

Background: Gastric cancer is a common malignancies worldwide, especially in East Asia. However, the 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 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% v.s. 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, were 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 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.