[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Aim: This study investigated the effects of preoperative nutritional status on postoperative outcomes in elderly patients with pancreatic adenocarcinoma.
Methods: The background and perioperative factors of patients who underwent pancreatectomy for pancreatic adenocarcinoma between 2007 and 2020 were retrospectively analyzed.
Results: Regarding background factors, patients aged 75 or over were significantly associated with hypertension, upfront surgery, and lower prognostic nutritional index. In addition, these patients had a significantly lower rate of portal vein resection, less blood loss, and shorter operation time than patients aged ＜ 75. During the postoperative course, they had a higher rate of pneumonia and lower overall survival than younger patients, although recurrence‐free survival was comparable. In the patients aged 75 or over, preoperative malnutrition was demonstrated to be a risk factor for postoperative in‐hospital death.
Conclusions: Surgical treatment for pancreatic cancer in patients aged 75 or over was performed safely. However, preoperative malnutrition is a risk factor for in‐hospital death and such patients require nutritional support and less‐invasive surgery.

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A 68‐year‐old man was referred to our department because he was diagnosed with gastric antrum cancer with advanced lymph node metastasis during an examination for epigastric pain. Pyloric stenosis due to the tumor obstructed the passage, making oral intake difficult. Therefore, a W‐ED^® tube was placed, which has a double‐tube structure where one lumen is for gastric decompression and the other is for enteral nutrition. Enteral nutrition became possible by indwelling, and after completing 2 courses of neoadjuvant chemotherapy for advanced gastric cancer, distal gastrectomy （D2） was performed, and early discharge was possible. The W‐ED^® tube is useful for multidisciplinary treatment of gastric cancer with pyloric stenosis because it can be placed in a minimally invasive manner.

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Aim：The essential strategy for early normalization after surgery with the patient’s excellent satisfaction （ESSENSE） program, which focuses on the recovery of physical activity, is recommended in Japan to improve perioperative management. We investigated the safety and efficacy of perioperative management based on the ESSENSE program for elderly patients who underwent gastrectomy for gastric cancer. Method：We investigated 41 patients aged ＞75 years who underwent open gastrectomy for gastric cancer and were categorized into a perioperative management with conventional care group （C group, n＝22） and the ESSENSE-based enhanced recovery after surgery group （E group, n＝19）. We performed retrospective intergroup comparison of the patients’ background and postoperative outcomes. Results：The operative time was longer in group E than in group C；however, we observed no significant intergroup differences in patient background, tumor-related factors or surgical factors. The dates of starting the postoperative diet, removal of the nasogastric tube and removal of the drain were earlier in group E than in group C. Intestinal obstruction occurred in two patients in group E, although we observed no significant intergroup differences in postoperative complications. Dietary energy intake was significantly higher in group E than in group C. Postoperative physical activity recovered faster in group E than in group C, and the rate of weight loss one month after discharge was 3.3％ lower in group E than in group C. The length of hospital stay until discharge was allowed after surgery was significantly earlier in group E than in C group, although the length of postoperative hospitalization was not significantly different at 16 days in both groups. Readmission was required for 2 and 0 patients in groups C and E, respectively.
Conclusions：ESSENSE-guided perioperative management is safe and associated with low readmission rates, but postoperative ileus requires attention in elderly patients who undergo gastric cancer surgery.

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