低位直腸がんの根治切除後の術後回復、免疫調節、および生存率を改善する統合的心理社会的、睡眠、および栄養サポート：ランダム化比較試験

Patients undergoing low rectal cancer resection often experience psychological distress, sleep disturbance, nutritional decline, and functional impairment. Evidence for comprehensive supportive interventions is limited.

In this single-center RCT (n = 188), patients were randomized 1:1 to an integrative psychosocial-sleep-nutrition program or ERAS-based standard care. Outcomes included psychological distress (BDI-II, BAI), sleep quality (PSQI), anorectal (LARS) and sexual function (IIEF-5/FSFI), postoperative inflammatory markers, recovery, and 2-year survival.

At 24 months, intervention patients showed greater reductions in BDI-II (-5.2), BAI (-3.8), and PSQI (-2.9), lower major LARS prevalence (28.7 % vs 46.2 %), and higher IIEF-5/FSFI scores. Postoperative CRP, IL-6, and TNF-α were lower (p < 0.001). Two-year DFS and OS were 90.3 % vs 79.2 % (p = 0.028) and 93.6 % vs 82.5 % (p = 0.019), respectively.

Multimodal psychosocial, sleep, and nutritional support improves psychological, functional, immunologic, and survival outcomes after low rectal cancer surgery.