Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan; Department of Public Health, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan.
Cancer Epidemiol. 2023 Aug;85:102391. doi: 10.1016/j.canep.2023.102391. Epub 2023 May 17.
The coronavirus disease 2019 (COVID-19) pandemic forced us to accept changes in our usual diagnostic procedures and treatments for colorectal cancer. This study aimed to determine the impact of the pandemic on colorectal cancer treatment in Japan.
The number of colorectal surgeries, stoma constructions, stent placements or long tube insertions, and neoadjuvant chemoradiotherapies were determined each month using sampling datasets from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. The observation periods before and during the pandemic were January 2015 to January 2020 and April 2020 to January 2021, respectively. An interrupted time-series analysis was used to estimate the changes in the number of procedures during the pandemic.
The number of endoscopic surgeries for colon cancer significantly decreased in April and July 2020 and for rectal cancer in April 2020. Additionally, the number of laparoscopic and open surgeries for colon cancer significantly decreased in July 2020 and October 2020, respectively. The number of stoma constructions and stent placements or long tube insertions did not increase during the observation period. Neoadjuvant chemoradiotherapy for rectal cancer significantly increased in April 2020 but levels returned shortly thereafter. These results suggest that the recommendations to overcome the pandemic proposed by expert committees, including the replacement of laparoscopic surgery with open surgery, stoma construction to avoid anastomotic leak, and replacement of surgery on the ileus with stent placement, were not widely implemented in Japan. However, as an exception, neoadjuvant chemoradiotherapy for rectal cancer was performed as an alternative treatment to delay surgery in small quantities.
A declining number of surgeries raises concerns about cancer stage progression; however, we found no evidence to suggest cancer progression from the trajectory of the number of stoma constructions and stent placements. In Japan, even during the pandemic, conventional treatments were performed.
2019 年冠状病毒病（COVID-19）大流行迫使我们接受对结直肠癌常规诊断程序和治疗方法的改变。本研究旨在确定大流行对日本结直肠癌治疗的影响。
每月使用来自日本国民健康保险索赔和特定健康检查国家数据库的抽样数据集确定结直肠手术、造口术、支架放置或长管插入以及新辅助放化疗的数量。观察期分别为大流行前的 2015 年 1 月至 2020 年 1 月和大流行期间的 2020 年 4 月至 2021 年 1 月。使用中断时间序列分析来估计大流行期间手术数量的变化。
结肠癌的内镜手术数量在 2020 年 4 月和 7 月显著减少，直肠癌在 2020 年 4 月减少。此外，结肠癌的腹腔镜和开放手术数量分别在 2020 年 7 月和 10 月显著减少。造口术和支架放置或长管插入的数量在观察期间没有增加。新辅助放化疗治疗直肠癌的数量在 2020 年 4 月显著增加，但随后很快恢复。这些结果表明，专家委员会提出的克服大流行的建议，包括将腹腔镜手术替换为开放手术、造口术以避免吻合口漏、以及将手术治疗肠梗阻替换为支架放置等，在日本并未广泛实施。然而，作为一个例外，新辅助放化疗治疗直肠癌作为一种替代治疗方法，少量用于延迟手术。
手术数量的减少引起了对癌症分期进展的担忧；然而，我们没有发现证据表明从造口术和支架放置数量的轨迹来看癌症进展。在日本，即使在大流行期间，也进行了常规治疗。
