Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg University Hospital, Würzburg.
Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig.
Int J Surg. 2023 Apr 1;109(4):670-678. doi: 10.1097/JS9.0000000000000202.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is estimated to have claimed more than 6 million lives globally since it started in 2019. Germany was exposed to two waves of coronavirus disease 2019 in 2020, one starting in April and the other in October. To ensure sufficient capacity for coronavirus disease 2019 patients in intensive care units, elective medical procedures were postponed. The fraction of major abdominal cancer resections affected by these measures remains unknown, and the most affected patient cohort has yet to be identified.
This is a register-based, retrospective, nationwide cohort study of anonymized 'diagnosis-related group' billing data provided by the Federal Statistical Office in Germany. Cases were identified using diagnostic and procedural codes for major cancer resections. Population-adjusted cancer resection rates as the primary endpoint were compared at baseline (2012-2019) to those in 2020.
A change in resection rates for all analyzed entities (esophageal, gastric, liver, pancreatic, colon, rectum, and lung cancer) was observed from baseline to 2020. Total monthly oncological resections dropped by 7.4% (8.7% normalized to the annual German population, P =0.011). Changes ranged from +3.7% for pancreatic resections ( P =0.277) to -19.4% for rectal resections ( P <0.001). Reductions were higher during lockdown periods. During the first lockdown period (April-June), the overall drop was 14.3% (8.58 per 100 000 vs. 7.35 per 100 000, P <0.001). There was no catch-up effect during the summer months except for pancreatic cancer resections. In the second lockdown period, there was an overall drop of 17.3%. In subgroup analyses, the elderly were most affected by the reduction in resection rates. There was a significant negative correlation between regional SARS-CoV-2 incidences and resections rates. This correlation was strongest for rectal cancer resections (Spearman's r : -0.425, P <0.001).
The pandemic lockdowns had a major impact on the oncological surgical caseload in Germany in 2020. The elderly were most affected by the reduction. There was a clear correlation between SARS-CoV-2 incidences regionally and the reduction of surgical resection rates. In future pandemic circumstances, oncological surgery has to be prioritized with an extra focus on the most vulnerable patients.
自 2019 年爆发以来，据估计，严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）大流行已在全球范围内导致超过 600 万人死亡。德国在 2020 年经历了两波 2019 年冠状病毒病（COVID-19），一波始于 4 月，另一波始于 10 月。为确保重症监护病房 COVID-19 患者有足够的容量，推迟了择期医疗程序。受这些措施影响的主要腹部癌症切除术的比例尚不清楚，最受影响的患者群体尚未确定。
这是一项基于注册的、回顾性的、全国性的队列研究，使用德国联邦统计局提供的匿名“诊断相关组”计费数据。使用主要癌症切除术的诊断和程序代码确定病例。将 2012-2019 年的基线作为主要终点，与 2020 年的癌症切除术率进行比较。
从基线到 2020 年，所有分析实体（食管、胃、肝、胰腺、结肠、直肠和肺癌）的切除术率均发生变化。每月肿瘤总切除术下降 7.4%（归一化为每年德国人口为 8.7%，P=0.011）。变化范围从胰腺切除术的+3.7%（P=0.277）到直肠切除术的-19.4%（P<0.001）。封锁期间的降幅更高。在第一次封锁期间（4 月至 6 月），总体降幅为 14.3%（8.58 每 10 万 vs. 7.35 每 10 万，P<0.001）。夏季月份除胰腺癌切除术外，没有追赶效应。在第二次封锁期间，总降幅为 17.3%。在亚组分析中，老年人受切除术率下降的影响最大。区域 SARS-CoV-2 发病率与切除术率之间存在显著负相关。这种相关性在直肠癌切除术方面最强（Spearman 相关系数：-0.425，P<0.001）。
大流行封锁对 2020 年德国肿瘤外科工作量产生了重大影响。老年人受影响最大。区域 SARS-CoV-2 发病率与手术切除率下降之间存在明确的相关性。在未来的大流行情况下，肿瘤外科手术必须优先考虑，并特别关注最脆弱的患者。
