2018-2022年日本国家临床数据库对2019冠状病毒病大流行对腹腔镜胃癌和直肠癌远端胃切除术和低位前切除术短期预后的影响

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery Pub Date : 2024-12-23 DOI:10.1002/ags3.12901

Masafumi Inomata, Hideki Endo, Tomonori Akagi, Hidefumi Shiroshita, Shigeki Yamaguchi, Susumu Eguchi, Norihito Wada, Yukinori Kurokawa, Yosuke Seki, Yoshiharu Sakai, Hiroyuki Yamamoto, Yoshihiro Kakeji, Yuko Kitagawa, Akinobu Taketomi, Masaki Mori

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引用次数: 0

摘要

我们之前报道了在2019冠状病毒病大流行（2020年）早期腹腔镜胃远端切除术（LDG）和腹腔镜下前切除术（LLAR）的手术结果没有变化，尽管选择性手术的数量有所减少。2021年，COVID-19进一步传播，根据几个医学会的指导方针启动了疫苗接种和其他医疗措施。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，分析COVID-19感染的扩大及其传播对腹腔镜手术（包括机器人辅助手术）的影响。方法提取2018 - 2022年NCD中因癌症接受LDG和LLAR治疗的患者数据。获得了LDG和LLAR的数量，并使用标准化发病率/死亡率（SMR）评估了发病率和死亡率，即观察到的发病率与由非传染性疾病以前开发的风险计算器计算的预期发病率之比。结果LDG和LLAR病例数在大流行元年2020年有所下降，2022年继续下降至与2021年持平，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病例数量有所增加，但增幅低于大流行前的增幅。死亡率和吻合口漏是SMR评估的两个非常重要的并发症，与大流行前的水平相比，大流行期间没有恶化。结论在日本，即使在疫情蔓延的2022年，腹腔镜手术也是安全的，没有受到新冠肺炎疫情的影响。

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Effect on short-term outcomes of the COVID-19 pandemic following laparoscopic distal gastrectomy and low anterior resection for gastric and rectal cancer: A retrospective study using the Japanese National Clinical Database, 2018–2022

Aims

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).

Methods

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.

Results

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.