Takeuchi Masashi, Endo Hideki, Hibi Taizo, Seishima Ryo, Takemura Yusuke, Yamamoto Hiroyuki, Maeda Hiromichi, Taketomi Akinobu, Kakeji Yoshihiro, Seto Yasuyuki, Ueno Hideki, Mori Masaki, Shirabe Ken, Kitagawa Yuko
Department of Surgery Keio University School of Medicine Tokyo Japan.
Department of Healthcare Quality Assessment, Graduate School of Medicine The University of Tokyo Tokyo Japan.
Ann Gastroenterol Surg. 2024 Nov 26;9(3):448-455. doi: 10.1002/ags3.12891. eCollection 2025 May.
Previous studies indicated that short-term outcomes for gastroenterological surgeries did not worsen during the COVID-19 pandemic. However, it remains unclear whether surgical volumes and medical resource use have recovered postpandemic. This study examines pre- and postpandemic trends in upper gastrointestinal surgeries, including esophagectomy and gastrectomy, and their short-term outcomes.
Data from the Japan's National Clinical Database (NCD) were analyzed for patients who underwent esophagectomy for esophageal cancer and gastrectomy for gastric cancer between January 2018 and December 2023. We evaluated changes in surgical volume, intensive care unit (ICU) use, morbidity, mortality rates, and the standardized morbidity and mortality ratio (SMR)-a comparison of observed versus expected outcomes using an NCD-established risk calculator. Key metrics included 30d mortality, surgical mortality, and four major morbidities like pneumonia and anastomotic leakage.
Esophagectomy volumes remained stable from 2018 to 2023, while gastrectomy volumes decreased notably over the past 6 y. The proportion of patients over 70 increased significantly in both surgery types. Morbidity and mortality rates showed no significant deterioration postpandemic, as indicated by SMR values.
This study analyzed changes in surgical volume and short-term outcomes for upper gastrointestinal cancer in the post-COVID-19 era using a Japanese nationwide database. It found that surgical treatments for gastrectomy and esophagectomy remained safe even after the pandemic.
先前的研究表明，在新冠疫情期间，胃肠外科手术的短期结果并未恶化。然而，疫情后手术量和医疗资源使用是否已恢复仍不清楚。本研究调查了包括食管癌切除术和胃癌切除术在内的上消化道手术在疫情前后的趋势及其短期结果。
分析了日本国家临床数据库（NCD）中2018年1月至2023年12月期间因食管癌接受食管癌切除术和因胃癌接受胃癌切除术患者的数据。我们评估了手术量、重症监护病房（ICU）使用情况、发病率、死亡率以及标准化发病率和死亡率比（SMR）——使用NCD建立的风险计算器对观察到的结果与预期结果进行比较。关键指标包括30天死亡率、手术死亡率以及肺炎和吻合口漏等四种主要并发症。
2018年至2023年期间，食管癌切除量保持稳定，而胃癌切除量在过去6年中显著下降。两种手术类型中70岁以上患者的比例均显著增加。如SMR值所示，疫情后发病率和死亡率没有显著恶化。
本研究使用日本全国性数据库分析了新冠疫情后时代上消化道癌手术量和短期结果的变化。研究发现，即使在疫情之后，胃癌切除术和食管癌切除术的外科治疗仍然是安全的。
