Nihon Geka Gakkai Zasshi
· 2016 May · PMID 30160414
Nutritional management is a type of basic therapy common to the treatment of all diseases. Appropriate nutritional management in response to the needs of individual patients is called nutrition support, and an interdisci...Nutritional management is a type of basic therapy common to the treatment of all diseases. Appropriate nutritional management in response to the needs of individual patients is called nutrition support, and an interdisciplinary group performing this function is called a nutrition support team (NST). The NST concept began with the development of total parenteral nutrition in 1968, although it did not immediately spread to Japan. In 1998, the potluck party method, a uniquely Japanese administrative system, was proposed, and NSTs were established in facilities throughout the country. In 2001, the Japanese Society for Parenteral and Enteral Nutrition planned the NST Project to support the establishment of NSTs under societal guidance. From 2006, the basic activities of NSTs in hospitals have been covered by healthcare fees. By 2010, the full range of activity of NSTs had been recognized as a necessary medical service in Japan with its aging population, and total medical fees for NST activities were covered by the social insurance system. By the end of 2014, NSTs had been established in more than 1,480 facilities nationwide. NSTs are now recognized as one of the most important medical tools available, including their social nutrition activities. Therefore, NSTs are expected to have increasing therapeutic usefulness in Japanese society with its growing proportion of elderly residents.
Nihon Geka Gakkai Zasshi
· 2016 May · PMID 30160408
Postoperative infections are classified into surgical site infections and remote infections. The risk factors associated with postoperative infections are related to medical practice, the patient, and bacteria. Postopera...Postoperative infections are classified into surgical site infections and remote infections. The risk factors associated with postoperative infections are related to medical practice, the patient, and bacteria. Postoperative infections not only prolong hospitalizations and increase patient burden but also affect prognosis. It is therefore important to conduct surveillance of postoperative complications at each facility to elucidate the risk factors for infection and to implement and evaluate infection control measures. Moreover, with the aging of the population, more surgeries are being performed in elderly individuals. However, the elderly tend to have age-related declines in the function of major organs as well as comorbidities, and surgeries in them carry a high risk despite advances in operative techniques and perioperative management. It is therefore important to determine surgical indications carefully by sufficiently assessing the risk preoperatively and performing appropriate perioperative management.
Namikawa T, Munekage M, Kitagawa H
… +2 more, Munekage E, Hanazaki K
Nihon Geka Gakkai Zasshi
· 2016 May · PMID 30160405
During the perioperative period, hyperglycemia is induced by surgical stress, which is the main risk factor for the development of postoperative infection associated with failure of neutrophil function, resulting in gluc...During the perioperative period, hyperglycemia is induced by surgical stress, which is the main risk factor for the development of postoperative infection associated with failure of neutrophil function, resulting in glucose toxicity. In elderly people with weakened immune systems, it is important to control perioperative hyperglycemia by maintaining sufficient nutrition administration. The artificial endocrine pancreas system allows strict glycemic control, which is beneficial in reducing glucose toxicity including postoperative infection not only in patients with diabetes mellitus or glucose intolerance but also in those who develop surgical diabetes during the perioperative period. Furthermore, it can contribute to the prevention of hypoglycemia and medical staff workload reduction. Therefore, the artificial pancreas is expected to come into widespread use in various fields involving glycemic control in patients.
Saji H, Sakai H, Kimura H
… +5 more, Miyazawa T, Tagaya R, Marushima H, Kurimoto N, Nakamura H
Nihon Geka Gakkai Zasshi
· 2016 May · PMID 30160404
According to the 2012 annual report of the Japanese Association for Thoracic Surgery, the total number of surgical procedures performed for the treatment of lung cancer had reached 35,667. Patients over 70 years of age c...According to the 2012 annual report of the Japanese Association for Thoracic Surgery, the total number of surgical procedures performed for the treatment of lung cancer had reached 35,667. Patients over 70 years of age comprised 52% of those surgical cases, and those over 80 years 12%. This tendency has been increasing annually. Although hospital mortality rates in elderly patients over 80 years of age and others were almost the same, 30% of elderly patients died from other diseases, as reported by the Japanese Joint Committee of the Lung Cancer Registry in 1999. Therefore, current preoperative physiological and oncological risk evaluations of elderly patients do not appear to be sufficient. The Japanese Association for Chest Surgery planned and performed a multiinstitutional prospective cohort study of elderly patients with lung cancer who underwent thoracic surgery to answer clinical questions surrounding such risk evaluations.
Nihon Geka Gakkai Zasshi
· 2016 May · PMID 30160399
The intravascular approach to cardiovascular surgery is extending the indications for the aging population. Because transaortic aortic valve replacement does not require opening the chest, the procedure benefits high-ris...The intravascular approach to cardiovascular surgery is extending the indications for the aging population. Because transaortic aortic valve replacement does not require opening the chest, the procedure benefits high-risk patients including the elderly. The introduction of open stenting to distal arch replacement and the hybrid approach to thoracoabdominal aneurysm repair significantly reduced surgical invasiveness. Well-established beating-heart surgery for coronary artery bypass grafting has become common in Japan. It is also contributing to reducing the risk to the aging population. Meticulous perioperative care for older patients, especially screening for vascular complications, is mandatory. Arterial diseases including those of the coronary, cerebrovascular, and peripheral arteries frequently occur in the elderly. The precise identification of risk factors and adequate perioperative care of complications are keys to the successful management of older patients who undergo cardiovascular surgery.
Yoshizumi T, Harimoto N, Itoh S
… +4 more, Ikegami T, Uchiyama H, Ikeda T, Maehara Y
Nihon Geka Gakkai Zasshi
· 2016 May · PMID 30160398
The aging of Japan’s population is becoming pronounced, and hepatobiliary pancreatic surgery for elderly patients is increasingly performed. Elderly patients generally have extensive comorbidities, the risk of malnutriti...The aging of Japan’s population is becoming pronounced, and hepatobiliary pancreatic surgery for elderly patients is increasingly performed. Elderly patients generally have extensive comorbidities, the risk of malnutrition, and diminished renal, liver, and cardiopulmonary function. Therefore, the indications of surgery should be individually evaluated considering surgical risk, impaired quality of life, and prognosis after surgery. Japanese insurance allows left lateral segmentectomy and partial resection for liver malignancy to be performed by laparoscopic surgery. Laparoscopic surgery may prevent sarcopenia, which is a predictor of survival in patients with various malignancies or those with liver cirrhosis. Elderly patients often develop delirium or severe aspiration pneumonia postoperatively. Interprofessional collaboration for pain control and early mobilization is the key to prevent severe complications in elderly patients. Thirty percent of patients with hepatocellular carcinoma are older than 75 years of age. Morbidity and mortality rates after hepatic resection in the elderly with acceptable cardiopulmonary function are comparable to those in younger individuals with adequate patient selection. Recipient age does not affect the outcome after living-donor liver transplantation (LDLT), as long as patient status is relatively good. Therefore, age alone should not be considered a contraindication for LDLT.
Nihon Geka Gakkai Zasshi
· 2016 May · PMID 30160392
As a result of increasing life expectancy, the incidence of cancer diagnosed in the older population is rising. The therapeutic strategies for elderly patients are generally difficult to determine due to comorbidity, fun...As a result of increasing life expectancy, the incidence of cancer diagnosed in the older population is rising. The therapeutic strategies for elderly patients are generally difficult to determine due to comorbidity, functional status, and socioeconomic aspects. For esophageal cancer, strict operative indications as well as advances in perioperative management have resulted in marked improvement of surgical outcomes after esophagectomy even in elderly patients. Laparoscopic surgery for gastric cancer and colorectal cancer spread rapidly throughout Japan, and reasonable surgical outcomes have been reported in the elderly. In future, objective assessments of the surgical stress of treatment will be essential. Furthermore, clinical research based on geriatric assessment scores are warranted for elderly patients with gastrointestinal cancers.