Abstract
BackgroundIn April 2017, we launched the multidisciplinary Hamamatsu Perioperative Care Team (HOPE) for all surgical patients. We developed a reinforced intervention strategy, particularly for esophagectomy. We herein report the outcomes of the HOPE at 2 years after commencement.MethodsA total 125 patients underwent esophagectomy and gastric conduit reconstruction for esophageal or esophagogastric junction cancer between January 2014 and December 2018 at the Department of Surgery in Hamamatsu University School of Medicine. The patients were divided into the pre-HOPE group including 62 patients who underwent esophagectomy before the introduction of the HOPE and the HOPE group including 63 patients who underwent esophagectomy after the introduction of the HOPE. The outcomes of surgery were compared between the two groups.ResultsThere were no significant differences in the clinicopathological characteristics between the two groups. The incidence rates of atrial fibrillation and pneumonia were significantly lower in the HOPE group than in the pre-HOPE group (6% vs. 19%, p = 0.027 and 14% vs. 29%, p = 0.037, respectively). The estimated calorie doses at the time of discharge were approximately 750 and 1500 kcal/day in the pre-HOPE group and the HOPE group, respectively. The body weight loss was significantly less in the HOPE group than the pre-HOPE group at 1, 3, 6, and 12 months postoperatively than that before the surgery (p < 0.001).ConclusionsThe introduction of the multidisciplinary HOPE was associated with a significant reduction in the incidence of postoperative pneumonia and significantly less weight loss.
Highlights
Surgery plays a key role in the radical treatment of esophageal cancer
Recent advances in surgical techniques and perioperative management have dramatically improved the mortality rate; esophagectomy remains a highly invasive procedure and is associated with higher postoperative complication and mortality rates than surgery for other gastrointestinal cancers [1,2,3]. Postoperative complications such as anastomotic leakage, pneumonia, and surgical site infections result in extended hospitalization and impaired quality of life (QOL) [4]
Oral intake is not possible for several days after surgery, and difficulty with oral intake can continue over a longer time period due to anastomotic leakage and dysfunction in swallowing, which renders weight loss a major issue [7]
Summary
Recent advances in surgical techniques and perioperative management have dramatically improved the mortality rate; esophagectomy remains a highly invasive procedure and is associated with higher postoperative complication and mortality rates than surgery for other gastrointestinal cancers [1,2,3]. Postoperative complications such as anastomotic leakage, pneumonia, and surgical site infections result in extended hospitalization and impaired quality of life (QOL) [4]. Conclusions The introduction of the multidisciplinary HOPE was associated with a significant reduction in the incidence of postoperative pneumonia and significantly less weight loss
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