Inomata Masafumi, Endo Hideki, Akagi Tomonori, Shiroshita Hidefumi, Yamaguchi Shigeki, Eguchi Susumu, Wada Norihito, Kurokawa Yukinori, Seki Yosuke, Sakai Yoshiharu, Yamamoto Hiroyuki, Kakeji Yoshihiro, Kitagawa Yuko, Taketomi Akinobu, Mori Masaki
Academic Committee of Japan Society for Endoscopic Surgery Tokyo Japan.
Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.
Ann Gastroenterol Surg. 2024 Dec 23;9(3):619-627. doi: 10.1002/ags3.12901. eCollection 2025 May.
We previously reported no change in surgical outcomes for laparoscopic distal gastrectomy (LDG) and laparoscopic low anterior resection (LLAR) early in the COVID-19 pandemic (2020), although the number of elective surgeries decreased. In 2021, COVID-19 spread further, with vaccination and other medical measures based on several medical societies' guidelines being initiated. Using the Japanese National Clinical Database (NCD), we added 2022 data to the 2018-2021 data to analyze the impacts of expansion of the COVID-19 infection and its spread on laparoscopic surgery (including robot-assisted surgery).
Data on patients who underwent LDG and LLAR for cancer were extracted from the NCD between 2018 and 2022. The numbers of LDG and LLAR were obtained, and morbidity and mortality rates were evaluated using a standardized morbidity/mortality ratio (SMR), i.e. the ratio of the observed number of incidences to expected number of incidences calculated by the risk calculator previously developed by the NCD.
The numbers of LDG and LLAR cases declined in 2020, the first pandemic year, and continued to decline in 2022 to the same level as 2021, but with no further decline and no recovery trend in the number of cases. Numbers of robot-assisted LDG and LLAR cases increased but at a rate lower than the prepandemic increase. Mortality and anastomotic leakage, two very important complications assessed in SMR, did not worsen during the pandemic compared to prepandemic levels.
In Japan, laparoscopic surgery was safe and unaffected by the COVID-19 pandemic, even in 2022, when the epidemic spread.
我们之前报道过，在2019冠状病毒病（COVID-19）大流行早期（2020年），尽管择期手术数量有所减少，但腹腔镜远端胃切除术（LDG）和腹腔镜低位前切除术（LLAR）的手术结果并无变化。2021年，COVID-19进一步传播，基于多个医学学会的指南开始了疫苗接种及其他医疗措施。利用日本国家临床数据库（NCD），我们将2022年的数据添加到2018 - 2021年的数据中，以分析COVID-19感染扩大及其传播对腹腔镜手术（包括机器人辅助手术）的影响。
从NCD中提取2018年至2022年因癌症接受LDG和LLAR的患者数据。获取LDG和LLAR的病例数，并使用标准化发病率/死亡率（SMR）评估发病率和死亡率，即观察到的发病数与NCD之前开发的风险计算器计算出的预期发病数之比。
在大流行的第一年2020年，LDG和LLAR病例数下降，并在2022年持续下降至与2021年相同水平，但病例数没有进一步下降，也没有恢复趋势。机器人辅助的LDG和LLAR病例数有所增加，但增速低于大流行前。与大流行前水平相比，在大流行期间，SMR评估的两个非常重要的并发症——死亡率和吻合口漏并未恶化。
在日本，即使在2022年疫情蔓延时，腹腔镜手术也是安全的，且未受COVID-19大流行的影响。
