Perioperative Symptoms: A New Frontier for Surgical Palliative Care.
Perioperative Symptoms: A New Frontier for Surgical Palliative Care.
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围手术期症状：外科姑息治疗的新领域。
DOI：
10.1097/sla.0000000000004698
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发表时间：
2021
影响因子：
9
通讯作者：
Cooper,Zara
中科院分区：
文献类型：
--
作者：
Lilley,ElizabethJ;Baig,HumaS;Cooper,Zara
2005年，美国外科医生学会发表声明，主张姑息治疗应在控制外科重症患者的症状方面发挥至关重要的作用，并强调这一作用不仅限于生命末期的护理，而且适用于治疗的所有阶段。[1]在随后的15年里，人们越来越认识到姑息治疗有助于解决沟通困难，改善手术患者的临终关怀;然而，姑息治疗在围手术期解决症状方面的作用尚未得到充分探讨。面临潜在治愈性切除的癌症患者在手术前通常会出现癌症相关症状。癌症治疗的进步已经允许对以前不适合手术的患者进行手术干预。随着新辅助化疗和放疗的使用越来越普遍，越来越多的患者面临大手术，同时仍然经历这些治疗的毒性作用。先前的工作已经证明了术前症状（包括疼痛、社会功能、焦虑和活动水平）与术后结局（包括发病率、死亡率、护理满意度和生活质量）之间的相关性。2术前症状评估和干预可能有助于在手术前控制这些症状。此外，在重大肿瘤手术前确定有复杂或难治性症状的患者可以从姑息治疗团队提供的跨学科专业知识中受益。
In 2005, the American College of Surgeons issued a statement asserting that palliative care should play a vital role in managing symptoms for seriously ill surgical patients, and emphasized that this role is not limited to care at the end of life, but is also appropriate for all phases of treatment. 1 In the ensuing 15 years, there has been growing recognition that palliative care supports difficult communications and improves end-of-life care for surgical patients; however, its role in addressing symptoms in the perioperative period has not been adequately explored.Patients with cancer who are facing potentially curative resection often have cancer-related symptoms before surgery. Advances in cancer therapeutics have permitted operative interventions in patients who previously would not have been surgical candidates. As the use of neoadjuvant chemotherapy and radiation have become increasingly common, growing numbers of patients face major surgery while still experiencing the toxic effects of these treatments. Prior work has demonstrated an association between preoperative symptoms, including pain, social functioning, anxiety, and activity level, and postoperative outcomes, including morbidity, mortality, satisfaction with care, and quality of life. 2 Preoperative symptom assessment and intervention may help control these symptoms in advance of surgery. Furthermore, patients identified to have complex or refractory symptoms before major oncologic surgery could benefit from the interdisciplinary expertise that palliative care teams provide.