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開催概要
開催回
第58回・2020年・京都
 

食道癌術後低栄養が予後に与える影響とチーム医療介入の効果

演題番号 : WS18-3

[筆頭演者]
曽根田 亘:1 
[共同演者]
平松 良浩:1,2、川田 三四郎:1、本家 淳子:2、渡邉 浩司:2,3、羽田 綾馬:1、廣津 周:1、松本 知拓:1、森田 剛文:1、菊池 寛利:1、馬場 恵:1、神谷 欣志:1、今野 弘之:4、竹内 裕也:1

1:浜松医科大学・第二外科、2:浜松医科大学・周術期等生活機能支援学、3:浜松医科大学・リハビリテーション科、4:浜松医科大学

 

[Aim] In our institute, a multidisciplinary perioperative management team was established in April 2017. Especially for patients with esophagectomy, individual dietary protocol has been served to prevent aspiration pneumonia. Here, we analyzed the effects of complications and malnutrition on the prognosis, and examined the effectiveness of medical team management.
[Method] Patients who underwent esophagectomy for esophageal cancer or esophagogastric junction cancer between Jan 2009 and Nov 2019 were reviewed. Overall, 221 patients were evaluated. The Onodera's prognostic nutritional index (PNI) at 1 month after surgery was calculated, and cases with -1 SD or less were defined as postoperative low PNI. <Analysis 1> We analyzed the effects of pStage, complications, and postoperative low PNI on overall survival (OS). <Analysis 2> The patients were divided into the pre-team group (n=128) who underwent surgery before the start of team management and the team group (n=93) with the team management. The outcomes of surgery were compared between the two groups.
[Results] <Analysis 1> Pneumonia, anastomotic leakage (leak), and surgical site infection (SSI) did not significantly correlate with OS. Postoperative low PNI group (n = 31, PNI<33.6) had significantly poor OS (HR2.49, p=0.003). In the multivariate analysis, postoperative low PNI was also an independent poor OS factor (HR1.96, p = 0.029). The patients with infectious complications (pneumonia, leak, and SSI) of Clavien-Dindo classification Grade II or higher resulted in postoperative low PNI at a significantly higher rate than those without complications (26%:3 %, p <0.001). <Analysis 2> There were significantly fewer postoperative low PNI cases in the team group than in the pre-team group (20%:5%, p=0.001).
[Discussion] Postoperative low PNI was a significant prognostic factor. It is important not only to prevent complications but also to prevent malnutrition even if with complications.

キーワード

臓器別:食道

手法別:チーム医療

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