Kitahata Yuji, Hirono Seiko, Kawai Manabu, Okada Ken-Ichi, Miyazawa Motoki, Shimizu Atsushi, Kobayashi Ryouhei, Ueno Masaki, Hayami Shinya, Shimokawa Toshio, Kouda Ken, Tajima Fumihiro, Yamaue Hiroki
Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan.
Langenbecks Arch Surg. 2018 Sep;403(6):711-718. doi: 10.1007/s00423-018-1710-1. Epub 2018 Sep 15.
Although the mortality rate for pancreaticoduodenectomy (PD) has decreased to around 2.8-5% in high-volume centers, postoperative complications are still common in 30-50% of cases. Preoperative exercise, called "prehabilitation," has been recently reported to reduce the frequency of complications after surgery. This study aims to evaluate the impact of the intensive perioperative rehabilitation on improvement of surgical outcomes for patients undergoing PD.
Between 2003 and 2014, 576 consecutive patients underwent PD in Wakayama Medical University Hospital. Of these, 331 patients received perioperative rehabilitation combined with prehabilitation and postoperative rehabilitation between 2009 and 2014. Previously, 245 patients underwent PD without perioperative rehabilitation between 2003 and 2008. We compared surgical outcomes between the patients undergoing PD with and without perioperative rehabilitation to evaluate the efficacy of our rehabilitation program.
The frequency of pulmonary complications was significantly lower in patients undergoing PD with perioperative rehabilitation than those without (0.9% vs. 4.3%, P = 0.011). There were no significant differences in other complication or mortality rates. Length of hospital stay was also shorter in patients receiving perioperative rehabilitation than that of those not receiving it (16 vs. 24 days, P < 0.001).
Intensive perioperative rehabilitation might reduce postoperative pulmonary complications and shorten postoperative hospital stay after PD. Therefore, we suggest that perioperative rehabilitation should be included as part of enhanced recovery after surgery for patients undergoing PD, although further large-scale studies are necessary to confirm our results.
尽管在高容量中心，胰十二指肠切除术（PD）的死亡率已降至约2.8%-5%，但术后并发症在30%-50%的病例中仍然很常见。术前运动，即“预康复”，最近有报道称可降低术后并发症的发生率。本研究旨在评估围手术期强化康复对接受PD手术患者手术结局改善的影响。
2003年至2014年期间，和歌山县医科大学医院连续576例患者接受了PD手术。其中，331例患者在2009年至2014年期间接受了围手术期康复，包括预康复和术后康复。此前，245例患者在2003年至2008年期间接受了PD手术，但未进行围手术期康复。我们比较了接受和未接受围手术期康复的PD患者的手术结局，以评估我们康复计划的疗效。
接受围手术期康复的PD患者肺部并发症的发生率显著低于未接受康复的患者（0.9%对4.3%，P = 0.011）。其他并发症或死亡率无显著差异。接受围手术期康复的患者住院时间也比未接受康复的患者短（16天对24天，P < 0.001）。
围手术期强化康复可能会降低PD术后肺部并发症的发生率，并缩短术后住院时间。因此，我们建议围手术期康复应作为接受PD手术患者术后加速康复的一部分，尽管需要进一步的大规模研究来证实我们的结果。
