Hu CC, Li N, Wang BY, Yu YW, Yu W. Letter to the Editor: Toward immune-adaptive anesthesia: Rethinking dexmedetomidine beyond sedation in gastrointestinal cancer surgery. World J Gastrointest Surg 2026; 18(3): 116619 [DOI: 10.4240/wjgs.v18.i3.116619]
Corresponding Author of This Article
Yong-Wei Yu, Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou 310003, Zhejiang Province, China. yuyongwei@zju.edu.cn
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Anesthesiology
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Mar 27, 2026 (publication date) through Mar 31, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Hu CC, Li N, Wang BY, Yu YW, Yu W. Letter to the Editor: Toward immune-adaptive anesthesia: Rethinking dexmedetomidine beyond sedation in gastrointestinal cancer surgery. World J Gastrointest Surg 2026; 18(3): 116619 [DOI: 10.4240/wjgs.v18.i3.116619]
World J Gastrointest Surg. Mar 27, 2026; 18(3): 116619 Published online Mar 27, 2026. doi: 10.4240/wjgs.v18.i3.116619
Letter to the Editor: Toward immune-adaptive anesthesia: Rethinking dexmedetomidine beyond sedation in gastrointestinal cancer surgery
Chu-Chu Hu, Ning Li, Bo-Yi Wang, Yong-Wei Yu, Wei Yu
Chu-Chu Hu, Ning Li, Wei Yu, Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Bo-Yi Wang, Operating Room, Hangzhou Institute of Medicine, Zhejiang Cancer Hospital, Chinese Academy of Sciences, Hangzhou 310005, Zhejiang Province, China
Yong-Wei Yu, Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Wei Yu, Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Co-first authors: Chu-Chu Hu and Ning Li.
Co-corresponding authors: Yong-Wei Yu and Wei Yu.
Author contributions: Hu CC and Li N wrote the manuscript; Wang BY collecting relevant references; Yu YW and Yu W designed the study and revised the manuscript. All listed authors consent to the submission. Hu CC and Li N contributed equally to this work as co-first authors. The designation of two co-corresponding authors reflects the interdisciplinary and practice-oriented nature of this Letter to the Editor. Yu YW contributed to the conceptual development of the manuscript, coordinated the overall structure, and led the interpretation from a critical care and postoperative management perspective. As a physician in intensive care medicine, he integrated perioperative monitoring, immune resilience, and recovery-related insights, and served as the primary contact during the initial invitation and submission process. Yu W provided complementary expertise from a senior nursing and perioperative care perspective. With extensive clinical experience in the operating room, gastrointestinal surgery wards, and gastroenterology units, and currently working in a cardiovascular ward, she contributed substantially to the nursing-related interpretation, perioperative care integration, and interdisciplinary applicability of the proposed concept. Both authors were actively involved in manuscript drafting, critical revision, and approval of the final version, and both take full responsibility for the integrity of the work and are available for post-publication correspondence. Accordingly, designation as co-corresponding authors appropriately reflects their shared accountability and complementary contributions.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Yong-Wei Yu, Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou 310003, Zhejiang Province, China. yuyongwei@zju.edu.cn
Received: November 17, 2025 Revised: December 4, 2025 Accepted: December 31, 2025 Published online: March 27, 2026 Processing time: 132 Days and 1.1 Hours
Abstract
This Letter builds on a recent trial by Zeng et al in the recent issue of the World Journal of Gastrointestinal Surgery. The trial demonstrated that perioperative dexmedetomidine (DEX) protects the vascular endothelium and enhances recovery after gastrointestinal cancer surgery. Although the original study focused on the preservation of the endothelial glycocalyx, we propose a broader interpretation. DEX exemplifies the emerging paradigm of immune-adaptive anesthesia by modulating the perioperative immune balance beyond sedation and analgesia by attenuating cytokine storms. Thereby, stabilizing the microcirculation and promoting systemic homeostasis. Consequently, anesthetic agents should be reframed as immunophysiological modulators rather than passive adjuncts to surgery. We advocate integrating anesthesia into enhanced recovery programs to reprogram the postoperative immune responses. Within this framework, anesthetic choice affects recovery, immune resilience, and the risk of complications. Future clinical trials should move beyond hemodynamic endpoints to include immune restoration profiles, cytokine kinetics, and patient-centered outcomes. Viewing anesthesia as immunoadaptive may unlock strategies to optimize recovery and reduce inflammation-driven complications during oncological surgery.
Core Tip: Anesthetic agents influence postoperative recovery far beyond sedation. This letter introduces the concept of immune-adaptive anesthesia, highlighting dexmedetomidine’s capacity to modulate perioperative immune balance and accelerate recovery after gastrointestinal cancer surgery. By integrating anesthetic immunomodulation with surgical precision and evidence-based nursing interventions-such as thermoregulation, stress control, and early mobilization-the perioperative team can collectively enhance immune resilience, reduce complications, and achieve more holistic, patient-centered recovery outcomes in oncologic surgery.
