Published in:
01-10-2016 | Original Article
Improvement in short-term outcomes after esophagectomy with a multidisciplinary perioperative care team
Published in: Esophagus | Issue 4/2016
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Background
Esophagectomy for patients with esophageal cancer remains a high-risk surgery. We introduced a multidisciplinary perioperative management team in the Cancer Institute Hospital (PeriCan) to improve short-term outcomes after esophagectomy.
Methods
To clarify the effect of PeriCan, we compared short-term outcomes between patients who underwent esophagectomy 1 year before the introduction of PeriCan and those who underwent esophagectomy 1 year after the introduction.
Results
One hundred and thirteen patients who underwent esophagectomy between October 2012 and September 2013 were included in the “Before PeriCan” group, while 105 patients who underwent esophagectomy between October 2013 and September 2014 were included in the “PeriCan” group. The incidence of postoperative complications significantly decreased from 73 to 49 % (P = 0.0003) with the introduction of PeriCan. In particular, the incidence of postoperative pneumonia significantly decreased from 43 to 13 % (P < 0.0001). Before the introduction of PeriCan, almost 70 % of patients with recurrent laryngeal nerve palsy experienced postoperative pneumonia, but the incidence significantly decreased to 32 % after the introduction of PeriCan (P = 0.017). Although the operative approach differed between groups, significant reduction in pneumonia was observed both in patients who underwent open esophagectomy and in those who underwent minimally invasive esophagectomy.
Conclusion
The introduction of PeriCan significantly decreased the incidence of postoperative complications, especially pneumonia. Systematic and cooperative interaction among professionals as a perioperative team can minimize the risks associated with esophagectomy.