Harada Tsuyoshi, Tsuji Tetsuya, Fukushima Takuya, Konishi Nobuko, Nakajima Hiroki, Suzuki Katsuyoshi, Ikeda Tomohiro, Toyama Shusuke, Matsumori Keiji, Yanagisawa Takumi, Hashimoto Kakeru, Kagaya Hitoshi, Zenda Sadamoto, Kojima Takashi, Fujita Takeo, Ueno Junya, Hijikata Nanako, Ishikawa Aiko, Hayashi Ryuichi
Department of Rehabilitation Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Department of Rehabilitation Medicine, Keio University Graduate School, Shinjuku, Tokyo, Japan.
Esophagus. 2025 Mar 18. doi: 10.1007/s10388-025-01121-y.
Prehabilitation has been shown to prevent postoperative pneumonia and physical function decline after esophagectomy in recent systematic reviews and meta-analyses. However, the implementation status of prehabilitation for esophagectomy remains unknown. This nationwide survey was performed to investigate the current status of and barriers to prehabilitation before esophagectomy among Japanese hospitals.
This multicenter nationwide survey was performed using the postal mail method. The eligible facilities were 155 Japanese hospitals that had been certified as Authorized Institutes for Board-Certified Esophageal Surgeons by the Japan Esophageal Society within the past 10 years. We administered the original questionnaire to investigate the current status of prehabilitation before esophagectomy, excluding neoadjuvant therapy.
The response rate was 75% (117/155 facilities). The number of facilities providing prehabilitation for esophagectomy was 77 (66%), including prehabilitation in the preoperative outpatient setting in 39 (33%) and in the preoperative inpatient setting in 53 (45%). Among the facilities that did not provide prehabilitation, the most common reasons for not providing prehabilitation (i.e., responses of "agree" and "strongly agree" on questionnaire) were a lack of human resources, preoperative period too short to provide prehabilitation, difficultly using reimbursed medical fees, and no establishment of a standard prehabilitation program.
We elucidated the current implementation status of prehabilitation, identified the critical gap between evidence and practice. This information will contribute to building an effective medical system and framework of prehabilitation for patients with esophageal cancer in Japan and other countries.
在最近的系统评价和荟萃分析中，术前康复已被证明可预防食管癌切除术后的肺炎和身体功能下降。然而，食管癌术前康复的实施情况仍不清楚。本全国性调查旨在研究日本医院食管癌术前康复的现状及障碍。
本多中心全国性调查采用邮寄方式进行。符合条件的机构为过去10年内被日本食管癌学会认证为食管外科专科医师授权机构的155家日本医院。我们发放了原始问卷，以调查食管癌切除术前（不包括新辅助治疗）的术前康复现状。
回复率为75%（117/155家机构）。提供食管癌术前康复的机构有77家（66%），其中39家（33%）在术前门诊进行康复，53家（45%）在术前住院期间进行康复。在未提供术前康复的机构中，不提供术前康复的最常见原因（即问卷中“同意”和“强烈同意”)是缺乏人力资源、术前时间过短无法进行术前康复、难以使用医保报销费用以及未建立标准的术前康复计划。
我们阐明了术前康复的当前实施情况，确定了证据与实践之间的关键差距。这些信息将有助于为日本及其他国家的食管癌患者建立有效的医疗系统和术前康复框架。
