徳島大学病院 食道癌手術における周術期補助チーム医療の実績

Achievements of perioperative assist team medical care in esophageal cancer surgery, Tokushima University Hospital.

抄録

背景:

根治的食道切除術は侵襲が大きく、多くの術後合併症を伴う。術後のQOL低下は患者にとって深刻な問題であり、多職種連携による包括的な周術期管理が必要である。当院では2017年より周術期アシストチーム（OPERA）を立ち上げ、このニーズに対応している。

BACKGROUND: Radical esophagectomy is highly invasive and associated with many postoperative complications. A decline in postoperative QOL is a serious issue for patients, and comprehensive perioperative management through multidisciplinary cooperation is necessary. Our institution has established a perioperative assist team (OPERA) to address this need since 2017.

方法:

本研究は、2009年から2018年までにネオアジュバント化学療法および食道切除術を施行した食道がん患者109例を対象とした。O群はOPERA介入群を意味し57例、N群は非OPERA介入群を意味し52例であった。化学療法関連の有害事象の減少および術後転帰の改善に対するOPERA介入の効果をレトロスペクティブに調査した。

METHODS: This study included 109 patients with esophageal cancer who underwent neoadjuvant chemotherapy and esophagectomy from 2009 to 2018. O group, means OPERA intervention group, included 57 patients, and N group, means Non-OPERA intervention group, included 52 patients. The effects of the OPERA intervention on reducing chemotherapy-related adverse events and improving postoperative outcomes were retrospectively investigated.

結果:

OPERA介入は化学療法関連の有害事象の発生率を有意に減少させた（P=0.002）。特に、食欲不振と下痢、発熱性好中球減少症が有意に減少した（それぞれP<0.001、P=0.002、P=0.025）。術後、歩行開始日は有意に早く（P<0.001）、肺炎の発生率は低かった（P=0.022）。術後退院時、N群はO群に比べ有意に体重減少が大きかった（P=0.002）。5年生存率はO群で長かった（P=0.003）。

RESULTS: The OPERA intervention significantly reduced the incidence of chemotherapy-related adverse events (P=0.002). In particular, anorexia and diarrhea, febrile neutropenia were significantly reduced (P<0.001, P=0.002, P=0.025, respectively). Postoperatively, the start date of walking was significantly earlier (P<0.001), the incidence of pneumonia was lower (P=0.022). At the time of postoperative discharge, N group was significantly greater weight loss compared to O group (P=0.002). The 5-year survival rate was longer in O group (P=0.003).

結論:

OPERA介入は、化学療法関連の有害事象および術後合併症の発生率を減少させ、予後の改善に寄与した。J. Med.Invest.71 : 279-285, August, 2024.

CONCLUSION: The OPERA intervention reduced the incidence of chemotherapy-related adverse events and postoperative complications and helped improved prognosis. J. Med. Invest. 71 : 279-285, August, 2024.