1.
Kaibori M, Matsui K, Ishizaki M, Saito T, Kitade H, Matsui Y et al. (2009)
Hepatic resection for hepatocellular carcinoma in the elderly. J Surg Oncol
99:154-160.
2.
Iida H, Kaibori M, Matsui K, Ishizaki M, Kon M. (2017) Assessing the
feasibility of clinicopathological features of hepatic resection for
hepatocellular carcinoma in patients over 80 years of age. Mol Clin Oncol
6:29-38.
3.
Wu FH, Shen CH, Luo SC, Hwang JI, Chao WS, Yeh HZ et al. (2019) Liver
resection for hepatocellular carcinoma in oldest old patients. World J Surg
Oncol 17.
4.
Reddy SK, Barbas AS, Turley RS, Gamblin TC, Geller DA, Marsh JW et
al. (2011) Major liver resection in elderly patients: a multi-institutional
analysis. J Am Coll Surg 212:787-795.
5.
Nanashima A, Abo T, Nonaka T, Fukuoka H, Hidaka S, Takeshita H et al.
(2011) Prognosis of patients with hepatocellular carcinoma after hepatic
resection: are elderly patients suitable for surgery? J Surg Oncol 104:284291.
6.
Nozawa A, Kubo S, Takemura S, Sakata C, Urata Y, Nishioka T et al.
(2015) Hepatic resection for hepatocellular carcinoma in super-elderly
patients aged 80 years and older in the first decade of the 21st century.
Surg Today 45:851-857.
15
7.
Van Tuil T, Dhaif AA, Te Riele WW, Van Ramshorst B, Van Santvoort HC.
(2019) Systematic Review and Meta-Analysis of Liver Resection for
Colorectal Metastases in Elderly Patients. Digestive Surgery 36:111-123.
8.
Shirabe K, Kajiyama K, Harimoto N, Gion T, Tsujita E, Abe T et al. (2009)
Early outcome following hepatic resection in patients older than 80 years
of age. World J Surg 33:1927-1932.
9.
Tanaka S, Iida H, Ueno M, Hirokawa F, Nomi T, Nakai T et al. (2019)
Preoperative Risk Assessment for Loss of Independence Following
Hepatic Resection in Elderly Patients: A Prospective Multicenter Study.
Ann Surg. https://doi.org/10.1097/sla.0000000000003585.
10.
Owens WD, Felts JA, Spitznagel EL, Jr. (1978) ASA physical status
classifications: a study of consistency of ratings. Anesthesiology 49:239243.
11.
Haynes SR, Lawler PG. (1995) An assessment of the consistency of ASA
physical status classification allocation. Anaesthesia 50:195-199.
12.
Ranta S, Hynynen M, Tammisto T. (1997) A survey of the ASA physical
status classification: significant variation in allocation among Finnish
anaesthesiologists. Acta Anaesthesiol Scand 41:629-632.
13.
Mak PH, Campbell RC, Irwin MG. (2002) The ASA Physical Status
Classification:
inter-observer
consistency.
American
Society
of
Anesthesiologists. Anaesth Intensive Care 30:633-640.
14.
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET et
al. (1982) Toxicity and response criteria of the Eastern Cooperative
Oncology Group. Am J Clin Oncol 5:649-655.
16
15.
Bouten CVC, Koekkoek KTM, Verduin M, Kodde R, Janssen JD. (1997) A
triaxial accelerometer and portable data processing unit for the
assessment of daily physical activity. IEEE Transactions on Biomedical
Engineering 44:136-147.
16.
Iida H, Shimizu T, Maehira H, Kitamura N, Mori H, Miyake T et al. (2018)
A pilot study: The association between physical activity level using by
accelerometer and postoperative complications after hepatic resection.
Exp Ther Med 16:4893-4899.
17.
Nakazaki K, Kitamura S, Motomura Y, Hida A, Kamei Y, Miura N et al.
(2014) Validity of an algorithm for determining sleep/wake states using a
new actigraph. J Physiol Anthropol 33:31.
18.
Matsuo M, Masuda F, Sumi Y, Takahashi M, Yamada N, Ohira MH et al.
(2016) Comparisons of Portable Sleep Monitors of Different Modalities:
Potential as Naturalistic Sleep Recorders. Front Neurol 7:110.
19.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD
et al. (2009) The Clavien-Dindo classification of surgical complications:
five-year experience. Ann Surg 250:187-196.
20.
Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam
R et al. (2011) Posthepatectomy liver failure: a definition and grading by
the International Study Group of Liver Surgery (ISGLS). Surgery 149:713724.
21.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. (1999)
Guideline for Prevention of Surgical Site Infection, 1999. Centers for
Disease Control and Prevention (CDC) Hospital Infection Control
17
Practices Advisory Committee. Am J Infect Control 27:97-132; quiz 133134; discussion 196.
22.
Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR
et al. (2017) Centers for Disease Control and Prevention Guideline for the
Prevention of Surgical Site Infection, 2017. JAMA Surg 152:784-791.
23.
Barkley R, Khalil M, Shen P, Levine EA, Votanopoulos K, Clark CJ. (2020)
Feasibility of low-cost accelerometers in measuring functional recovery
after major oncologic surgery. J Surg Oncol 121:279-285.
24.
Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M.
(2008) Physical activity in the United States measured by accelerometer.
Med Sci Sports Exercise 40:181-188.
25.
Bankoski A, Harris TB, McClain JJ, Brychta RJ, Caserotti P, Chen KY et
al. (2011) Sedentary activity associated with metabolic syndrome
independent of physical activity. Diabetes Care 34:497-503.
26.
Healy GN, Matthews CE, Dunstan DW, Winkler EAH, Owen N. (2011)
Sedentary time and cardio-metabolic biomarkers in US adults: NHANES
200306. Euro Heart J 32:590-597.
27.
Stamatakis E, Hamer M, Tilling K, Lawlor DA. (2012) Sedentary time in
relation to cardio-metabolic risk factors: differential associations for selfreport vs accelerometry in working age adults. Int J Epidemiol 41:13281337.
28.
Trost SG, Kerr LM, Ward DS, Pate RR. (2001) Physical activity and
determinants of physical activity in obese and non-obese children. Int J
Obesity 25:822-829.
18
29.
Healy GN, Dunstan DW, Salmon J, Cerin E, Shaw JE, Zimmet PZ et al.
(2007)
Objectively
measured
light-intensity
physical
activity
is
independently associated with 2-h plasma glucose. Diabetes Care
30:1384-1389.
30.
Healy GN, Wijndaele K, Dunstan DW, Shaw JE, Salmon J, Zimmet PZ et
al. (2008) Objectively measured sedentary time, physical activity, and
metabolic risk the Australian Diabetes, Obesity and Lifestyle Study
(AusDiab). Diabetes Care 31:369-371.
31.
Cook DJ, Thompson JE, Prinsen SK, Dearani JA, Deschamps C. (2013)
Functional recovery in the elderly after major surgery: assessment of
mobility recovery using wireless technology. Ann Thorac Surg 96:10571061.
32.
Takahashi T, Kumamaru M, Jenkins S, Saitoh M, Morisawa T, Matsuda H.
(2015) In-patient step count predicts re-hospitalization after cardiac
surgery. J Cardiology 66:286-291.
33.
Taraldsen K, Sletvold O, Thingstad P, Saltvedt I, Granat MH, Lydersen S
et al. (2014) Physical behavior and function early after Hip Fracture
surgery in patients receiving comprehensive geriatric care or orthopedic
care - A randomized controlled trial. J Gerontology - Series A Biol Sci Med
Sci 69 A:338-345.
34.
Harding P, Holland AE, Delany C, Hinman RS. (2014) Do activity levels
increase after total hip and knee arthroplasty? Clin Orthopaedics Relate
Res 472:1502-1511.
19
35.
Harding PA, Holland AE, Hinman RS, Delany C. (2015) Physical activity
perceptions and beliefs following total hip and knee arthroplasty: a
qualitative study. Physiother Theory Pract 31:107-113.
36.
Toogood PA, Abdel MP, Spear JA, Cook SM, Cook DJ, Taunton MJ.
(2016) The monitoring of activity at home after total hip arthroplasty. Bone
Joint J 98-B:1450-1454.
37.
Schotanus MGM, Bemelmans YFL, Grimm B, Heyligers IC, Kort NP.
(2017) Physical activity after outpatient surgery and enhanced recovery
for total knee arthroplasty. Knee Surgery, Sports Traumatology,
Arthroscopy 25:3366-3371.
38.
Bond DS, Jakicic JM, Vithiananthan S, Thomas JG, Leahey TM, Sax HC
et al. (2010) Objective quantification of physical activity in bariatric surgery
candidates and normal-weight controls. Surg Obesity Relate Dis 6:72-78.
39.
Chumillas S, Ponce JL, Delgado F, Viciano V, Mateu M. (1998) Prevention
of
postoperative
pulmonary
complications
through
respiratory
rehabilitation: a controlled clinical study. Arch Phys Med Rehabil 79:5-9.
40.
Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS et al. (2013)
Impact of a trimodal prehabilitation program on functional recovery after
colorectal cancer surgery: a pilot study. Surg Endosc 27:1072-1082.
41.
Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A et al. (2014)
Prehabilitation versus rehabilitation: a randomized control trial in patients
undergoing colorectal resection for cancer. Anesthesiology 121:937-947.
20
42.
Grimes L, Outtrim JG, Griffin SJ, Ercole A. (2019) Accelerometery as a
measure of modifiable physical activity in high-risk elderly preoperative
patients: a prospective observational pilot study. BMJ Open 9.
21
Figure legends
Figure 1: Patterns of changes in physical activity levels from postoperative day
(POD) 1 to POD 7: (a.) upward slope type, (b.) bell curve type, (c.) flat type
Figure 2: Changes in physical activity and timings of complication detection in
10 patients with bell curve patterns of physical activity who developed
postoperative complications
A decrease in activity level is evident in all cases prior to the detection of
complications.
22
Table 1: Comparison of background factors, laboratory findings, and surgical factors between patients
displaying different patterns of changes in postoperative physical activity levels
Age (years)
Gender (n, %)
Body mass index (kg/m2)
Diabetes mellitus (n, %)
Alcohol abuse (n, %)
Etiology (n, %)
Cardiovascular disease (n, %)
Primary disease (n, %)
Albumin (g/dL)
ALT (IU/L)
AST (IU/L)
Total bilirubin (mg/dL)
Prothrombin activity (%)
Platelet count (x104/μL)
ICGR15 (%)
White blood count (x104/μL)
C-reactive protein (mg/dL)
Laparoscopic hepatectomy (n, %)
Operative methods (n, %)
Repeat hepatectomy (n, %)
Blood loss (mL)
Operative time (min)
Female
Male
HBV
HCV
NBNC
HCC
Meta
Other
Partial
Anatomical
Upward slope
(n = 88)
68.0 ± 11.5
31 (35.2)
57 (64.8)
23.3 ± 3.5
26 (29.5)
27 (30.7)
5 (5.7)
11 (12.5)
72 (81.8)
5 (5.7)
46 (52.3)
28 (31.8)
14 (15.9)
4.0 [3.6, 4.2]
23 [15, 31]
26 [20, 42]
0.68 [0.51, 0.89]
101 [91, 111]
161 [118, 214]
9.9 [5.2, 17.5]
4.7 [3.8, 5.5]
0.12 [0.06, 0.21]
59 (67.0)
63 (71.6)
25 (28.4)
26 (29.5)
99 [0, 300]
210 [159, 271]
Bell curve
(n = 13)
71.9 ± 9.1
2 (15.4)
11 (84.6)
20.8 ± 3.0
5 (38.5)
7 (53.8)
0 (0.0)
6 (46.2)
7 (53.8)
1 (7.7)
8 (61.5)
2 (15.4)
3 (23.1)
3.9 [3.8, 4.2]
21 [16, 26]
36 [23, 54]
0.69 [0.58, 0.84]
93 [86, 109]
156 [127, 180]
12.8 [7.1, 15.3]
4.2 [4.2, 4.7]
0.10 [0.04, 0.28]
4 (30.8)
4 (30.8)
9 (69.2)
4 (30.8)
602 [322, 1022]
290 [259, 328]
Flat
(n = 46)
70.2 ± 10.4
12 (26.1)
34 (73.9)
23.8 ± 3.9
15 (32.6)
18 (39.1)
1 (2.2)
12 (26.1)
33 (71.7)
8 (17.4)
30 (65.2)
13 (28.3)
3 (6.5)
3.9 [3.5, 4.1]
31 [16, 47]
32 [21, 50]
0.57 [0.47, 0.83]
94 [86, 106]
155 [121, 222]
12.1 [8.4, 20.0]
4.8 [4.2, 6.6]
0.12 [0.06, 0.41]
23 (50.0)
21 (45.7)
25 (54.3)
13 (28.3)
457 [121, 790]
279 [212, 347]
Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; NBNC, negative for hepatitis B and hepatitis
C virus; HCC, hepatocellular carcinoma; Meta, metastasis; ALT, alanine aminotransferase; AST, aspartate
aminotransferase; ICGR15, indocyanine green retention rate at 15 minutes.
Age and body mass index are expressed as mean ± standard deviation. Other data are expressed as median
with 25th and 75th percentiles.
p-value
0.345
0.253
0.034
0.789
0.215
0.03
0.088
0.298
0.395
0.299
0.182
0.438
0.193
0.833
0.292
0.207
0.609
0.017
0.001
0.98
< 0.001
< 0.001
Table 2: Comparison of postoperative complications between patients displaying different patterns of
changes in postoperative physical activity levels
All complications (n, %)
Surgical site infection (n, %)
PHLF (n, %)
Bile leakage (n, %)
Infectious complications (n, %)
Duration of hospitalization (days)
Grade B
Grade C
Upward slope
(n = 88)
4 (4.5)
0 (0.0)
1 (1.1)
0 (0.0)
0 (0.0)
0 (0.0)
9 [8, 12]
Bell curve
(n = 13)
10 (76.9)
4 (30.8)
1 (7.7)
1 (7.7)
1 (7.7)
4 (30.8)
14 [11, 33]
Flat
(n = 46)
30 (65.2)
11 (23.9)
5 (10.9)
4 (8.7)
6 (13.0)
16 (34.8)
12 [10, 22]
Abbreviations: PHLF, post-hepatectomy liver failure.
Duration of hospitalization (days) is expressed as median with 25th and 75th percentiles.
p-value
< 0.001
< 0.001
0.005
0.003
< 0.001
< 0.001
Table 3: Details of postoperative complication frequencies in groups of patients displaying different patterns
of changes in postoperative physical activity levels
Upward slope
(n = 4/88, 4.5%)
Thrombosis
(portal)
(n = 2)
Ileus
(n = 1)
Grade B PHLF (n = 1)
Bell curve
(n = 10/13, 76.9%)
Refractory pleural effusion or ascites
(n = 5)
(including 1 case of Grade B PHLF)
Flat
(n = 30/46, 65.2%)
Organ or space SSI
(including 6 cases of bile leakage,
3 cases of Grade B PHLF,
and 2 cases of Grade C PHLF)
(n = 10)
Organ or space SSI
(including 1 case of bile leakage)
(n = 3)
Pneumonia
(n = 4)
Superficial incisional SSI
(n = 1)
Thrombosis
(3 cases of portal thrombosis
and 1 case of pulmonary thrombosis)
(n = 4)
Biliary stricture with Grade C PHLF (n = 1)
Postoperative bleeding
(including 2 cases of Grade B PHLF)
(n = 3)
Ileus
(n = 2)
Refractory pleural effusion or ascites
(n = 2)
Delirium
(n = 2)
Superficial incisional SSI
(n = 1)
Infection of implant with Grade C PHLF (n = 1)
Grade C PHLF
Abbreviations: PHLF, post-hepatectomy liver failure; SSI, surgical site infection
(n = 1)
...
論文の公開元へ
