Skip to main content

Advertisement

SpringerLink
Log in

Analysis of the short-term outcomes after esophagectomy for esophageal cancer during the COVID-19 pandemic using data from a nationwide Japanese database

  • Original Article
  • Published:
Esophagus Aims and scope Submit manuscript

Abstract

Background

The coronavirus disease 2019 (COVID-19) pandemic had adversely impacted cancer screening, diagnosis, and treatment. We investigated the change in medical resource, such as the intensive care unit use, and short-term outcomes after esophagectomy during the pandemic.

Methods

Data of patients who underwent esophagectomy for esophageal cancer registered in the National Clinical Database (NCD) in Japan from January 2018 to December 2021 were analyzed. The time series change in the number of surgical cases; usage of intensive care unit; incidence of morbidity and mortality; standardized mortality and morbidity ratio (SMR) for 30-days mortality; surgical mortality; and morbidities for pneumonia, sepsis, unplanned intubation, and anastomotic leakage were evaluated.

Results

The annual number of patients undergoing esophagectomy remained similar from 2018 to 2021. The negative impact of the pandemic on medical resources was strongly identified in the patients from an epidemic area where there is a higher cumulative number of infections per population as compared to all prefectures. The proportions of patients admitted to the intensive care unit were 91.4%, 93.0%, 91.6%, and 90.5% in 2018, 2019, 2020, and 2021, respectively. Moreover, 93.3%, 94.0%, 92.0%, and 90.9% patients who underwent surgery in an epidemic area were admitted to the intensive care unit in 2018, 2019, 2020, and 2021, respectively. However, the morbidity and mortality rates during the pandemic did not worsen according to the SMR values.

Conclusions

Esophagectomy was performed during the pandemic despite limited medical resources by a systematic endeavor of the entire surgical department in Japan, without increasing the incidence rate of worse outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

It is not applicable.

References

  1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727–33. https://doi.org/10.1056/NEJMoa2001017.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Ministry of Health, Labour and Welfare, Japan. https://www.mhlw.go.jp/stf/covid-19/kokunainohasseijoukyou.html. Accessed 1 Dec 2022.

  3. Maeda H, Endo H, Yamamoto H, et al. Effects of the COVID-19 pandemic on gastroenterological surgeries in 2020: a study using the National Clinical Database of Japan. Ann Gastroenterol Surg. 2023. https://doi.org/10.1002/ags3.12638. (pub ahead of print 2022).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Driessen MLS, Sturms LM, Bloemers FW, et al. The detrimental impact of the COVID-19 pandemic on major trauma outcomes in the Netherlands: a comprehensive nationwide study. Ann Surg. 2022;275:252–8. https://doi.org/10.1097/SLA.0000000000005300.

    Article  PubMed  Google Scholar 

  5. Nepogodiev D, Omar OM, Glasbey JC. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg. 2020;107:1440–9. https://doi.org/10.1002/bjs.11746.

    Article  CAS  Google Scholar 

  6. Ikeda N, Yamamoto H, Taketomi A, et al. The impact of COVID-19 on surgical procedures in Japan: analysis of data from the National Clinical Database. Surg Today. 2022;52:22–35. https://doi.org/10.1007/s00595-021-02406-2.

    Article  CAS  PubMed  Google Scholar 

  7. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49. https://doi.org/10.3322/caac.21660.

    Article  PubMed  Google Scholar 

  8. Kakeji Y, Takahashi A, Hasegawa H, et al. Surgical outcomes in gastroenterological surgery in Japan: report of the National Clinical Database 2011–2018. Ann Gastroenterol Surg. 2020;4:250–74. https://doi.org/10.1002/ags3.12324.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Takeuchi M, Takeuchi H, Kawakubo H, et al. Perioperative risk calculator predicts long-term oncologic outcome for patients with esophageal carcinoma. Ann Surg Oncol. 2018;25:837–43. https://doi.org/10.1245/s10434-017-6311-7.

    Article  PubMed  Google Scholar 

  10. Booka E, Takeuchi H, Nishi T, et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Med (Baltim). 2015;94:e1369. https://doi.org/10.1097/MD.0000000000001369.

    Article  Google Scholar 

  11. Takeuchi M, Kawakubo H, Mayanagi S, et al. Postoperative pneumonia is associated with long-term oncologic outcomes of definitive chemoradiotherapy followed by salvage esophagectomy for esophageal cancer. J Gastrointest Surg. 2018;22:1881–9. https://doi.org/10.1007/s11605-018-3857-z.

    Article  PubMed  Google Scholar 

  12. Bhangu A, Nepogodiev D, Glasbey JC, et al. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet. 2020;396:27–38. https://doi.org/10.1016/S0140-6736(20)31182-X.

    Article  Google Scholar 

  13. Lal BK, Prasad NK, Englum BR, et al. Periprocedural complications in patients with SARS-CoV-2 infection compared to those without infection: a nationwide propensity-matched analysis. Am J Surg. 2021;222:431–7. https://doi.org/10.1016/j.amjsurg.2020.12.024.

    Article  PubMed  Google Scholar 

  14. Prasad NK, Lake R, Englum BR, et al. Increased complications in patients who test COVID-19 positive after elective surgery and implications for pre and postoperative screening. Am J Surg. 2022;223:380–7. https://doi.org/10.1016/j.amjsurg.2021.04.005.

    Article  PubMed  Google Scholar 

  15. Takeuchi H, Miyata H, Gotoh M, et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg. 2014;260:259–66. https://doi.org/10.1097/SLA.0000000000000644.

    Article  PubMed  Google Scholar 

  16. Kunisaki C, Makino H, Takagawa R, et al. Predictive factors for surgical complications of laparoscopy assisted distal gastrectomy for gastric cancer. Surg Endosc. 2009;23:2085–93. https://doi.org/10.1007/s00464-008-0247-8.

    Article  PubMed  Google Scholar 

  17. Kurita N, Miyata H, Gotoh M, et al. Risk model for distal gastrectomy when treating gastric cancer on the basis of data from 33,917 Japanese patients collected using a nationwide web-based data entry system. Ann Surg. 2015;262:295–303. https://doi.org/10.1097/SLA.0000000000001127.

    Article  PubMed  Google Scholar 

  18. Rice TW, Patil DT, Blackstone EH. 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothorac Surg. 2017;6:119–30. https://doi.org/10.21037/acs.2017.03.14.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hirahata K, Nawa N, Fujiwara T. Characteristics of long COVID: cases from the first to the fifth wave in Greater Tokyo. Jpn J Clin Med. 2022;11:6457. https://doi.org/10.3390/jcm11216457.

    Article  Google Scholar 

  20. Furukawa K, Tjan LH, Sutandhio S, et al. Cross-neutralizing activity against SARS-CoV-2 variants in COVID-19 patients: comparison of 4 waves of the pandemic in Japan. Open Forum Infect Dis. 2021;8:ofab430. https://doi.org/10.1093/ofid/ofab430.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Ohkura Y, Miyata H, Konno H, et al. Development of a model predicting the risk of eight major postoperative complications after esophagectomy based on 10 826 cases in the Japan National Clinical Database. J Surg Oncol. 2020;121:313–21. https://doi.org/10.1002/jso.25800.

    Article  PubMed  Google Scholar 

  22. Akahane T, Nakanishi Y, Yoshiji H, et al. Esophagogastroduodenoscopy screening intentions during the COVID-19 pandemic in Japan: web-based survey. JMIR Cancer. 2022;8:e40600. https://doi.org/10.2196/40600.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sagami R, Nishikiori H, Sato T, et al. Aerosols produced by upper gastrointestinal endoscopy: a quantitative evaluation. Am J Gastroenterol. 2021;116:202–5. https://doi.org/10.14309/ajg.0000000000000983.

    Article  CAS  PubMed  Google Scholar 

  24. Maruyama H, Hosomi S, Nebiki H, et al. Gastrointestinal endoscopic practice during COVID-19 pandemic: a multi-institutional survey. Rom J Intern Med. 2021;59:166–73. https://doi.org/10.2478/rjim-2020-0038.

    Article  PubMed  Google Scholar 

  25. Trindade AJ, Zhang J, Hauschild J, et al. Impact of coronavirus disease 2019 on the diagnosis and therapy for Barrett’s esophagus and esophageal cancer in the United States. Gastroenterology. 2022;162:978-80.e6. https://doi.org/10.1053/j.gastro.2021.11.020.

    Article  CAS  PubMed  Google Scholar 

  26. Takahashi A, Yamamoto H, Kakeji Y, et al. Estimates of the effects of centralization policy for surgery in Japan: does centralization affect the quality of healthcare for esophagectomies? Surg Today. 2021;51:1010–9. https://doi.org/10.1007/s00595-021-02245-.

    Article  PubMed  Google Scholar 

  27. Motoyama S, Maeda E, Yano M, et al. Esophagectomy performed at institutes certified by the Japan Esophageal Society provide long-term survival advantages to esophageal cancer patients: second report analyzing 4897 cases with propensity score matching. Esophagus. 2020;17:141–8. https://doi.org/10.1007/s10388-019-00712-w.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Motoyama S, Yamamoto H, Miyata H, et al. Impact of certification status of the institute and surgeon on short-term outcomes after surgery for thoracic esophageal cancer: evaluation using data on 16,752 patients from the National Clinical Database in Japan. Esophagus. 2020;17:41–9. https://doi.org/10.1007/s10388-019-00694-9.

    Article  PubMed  Google Scholar 

  29. Takeuchi H, Ito Y, Machida R, et al. A single-arm confirmatory study of definitive chemoradiation therapy including salvage treatment for clinical Stage II/III esophageal squamous cell carcinoma (JCOG0909 study). Int J Radiat Oncol Biol Phys. 2022;114:454–62. https://doi.org/10.1016/j.ijrobp.2022.07.007.

    Article  PubMed  Google Scholar 

  30. Kato K, Ito Y, Nozaki I, et al. Parallel-group controlled trial of surgery versus chemoradiotherapy in patients with Stage I esophageal squamous cell carcinoma. Gastroenterology. 2021;161:1878-86.e2. https://doi.org/10.1053/j.gastro.2021.08.007.

    Article  CAS  PubMed  Google Scholar 

  31. Kelly RJ, Ajani JA, Kuzdzal J, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med. 2021;384:1191–203. https://doi.org/10.1056/NEJMoa2032125.

    Article  CAS  PubMed  Google Scholar 

  32. Doki Y, Ajani JA, Kato K, et al. Nivolumab combination therapy in advanced esophageal squamous-cell carcinoma. N Engl J Med. 2022;386:449–62. https://doi.org/10.1056/NEJMoa2111380.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by MHLW Research Program on Emerging and Reemerging Infectious Diseases (Grant Number JPMH21HA2011).

Author information

Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan

    Masashi Takeuchi, Ryo Seishima, Yutaka Nakano & Yuko Kitagawa

  2. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan

    Hideki Endo, Hiroyuki Yamamoto & Hiroaki Miyata

  3. Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8582, Japan

    Taizo Hibi

  4. Department of Surgery, Kochi Medical School, Kochi, 783-8505, Japan

    Hiromichi Maeda & Kazuhiro Hanazaki

  5. Department of Gastroenterological Surgery I, Hokkaido University Hospital, Hokkaido, 060-8638, Japan

    Akinobu Taketomi

  6. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yoshihiro Kakeji & Hideki Ueno

  7. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan

    Yasuyuki Seto

  8. Tokai University, Kanagawa, 259-1292, Japan

    Masaki Mori

  9. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yuko Kitagawa

Authors
  1. Masashi Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hideki Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Taizo Hibi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryo Seishima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yutaka Nakano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroyuki Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroaki Miyata
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hiromichi Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kazuhiro Hanazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Akinobu Taketomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yoshihiro Kakeji
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yasuyuki Seto
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hideki Ueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Masaki Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yuko Kitagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Taizo Hibi.

Ethics declarations

Conflict of interest

Dr. Kitagawa reports grants and personal fees from ASAHI KASEI PHARMA CORPORATION, grants, personal fees, and others from ONO PHARMACEUTICAL CO., LTD., grants and personal fees from Otsuka Pharmaceutical Factory, Inc., grants and personal fees from Nippon Covidien Inc., grants, personal fees, and others from TAIHO PHARMACEUTICAL CO., LTD, grants, personal fees, and others from CHUGAI PHARMACEUTICAL CO., LTD., grants and personal fees from KAKEN PHARMACEUTICAL CO., LTD., personal fees from AstraZeneca K.K., personal fees from Ethicon Inc., personal fees from Olympus Corporation, personal fees from SHIONOGI & CO., LTD., personal fees and others from Bristol-Myers Squibb K.K., personal fees from MSD K.K., personal fees from Smith & Nephew KK, personal fees from ASKA Pharmaceutical Co., Ltd., personal fees from MIYARISAN PHARMACEUTICAL CO. LTD., personal fees from Toray Industries, Inc., personal fees from DAIICHI SANKYO COMPANY, LIMITED, personal fees from Chugai Foundation for Innovative Drug Discovery Science, personal fees from Nippon Kayaku Co., Ltd., grants from Yakult Honsha Co. Ltd., grants from Otsuka Pharmaceutical Co., Ltd., grants from TSUMURA & CO., grants from Sumitomo Pharma Co., Ltd., grants and personal fees from EA Pharma Co., Ltd., grants from Eisai Co., Ltd., grants from Kyowa Kirin Co., Ltd., grants from MEDICON INC., grants from Takeda Pharmaceutical Co., Ltd., grants from TEIJIN PHARMA LIMITED, and personal fees from Intuitive Surgical G.K., outside the submitted work. Hideki Endo, Hiroyuki Yamamoto, and Hiroaki Miyata are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by the National Clinical Database, Johnson & Johnson K.K., Nipro Corporation, and Intuitive Surgical Sàrl.

Ethical statement

The protocol of this study was reviewed and adopted by the Japanese Society of Gastrointestinal Surgery Committee and approved by the Institutional Review Board of Kochi Medical School with exemption of individual written informed consent owing to the retrospective study design (ID: 2022–75).

Informed Consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Online Resource 1. Flowchart of all patients who underwent esophagectomy (EPS 194 KB)

10388_2023_1017_MOESM2_ESM.eps

Online Resource 2. Trend in the number of patients undergoing esophagectomy according to age, and T factors. Solid and dash lines indicate patients who underwent esophagectomy in the 47 prefectures and those who underwent esophagectomy in epidemic areas, respectively. Blue and red lines indicate the proportion of elderly and advanced cancer patients, respectively. (EPS 773 KB)

10388_2023_1017_MOESM3_ESM.eps

Online Resource 3 Trend in the number of patients undergoing esophagectomy according to the lymph node stage. Solid and dash lines indicate patients who underwent esophagectomy in the 47 prefectures and those who underwent esophagectomy in epidemic areas, respectively. (EPS 765 KB)

Supplementary file4 (DOCX 49 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Takeuchi, M., Endo, H., Hibi, T. et al. Analysis of the short-term outcomes after esophagectomy for esophageal cancer during the COVID-19 pandemic using data from a nationwide Japanese database. Esophagus 20, 617–625 (2023). https://doi.org/10.1007/s10388-023-01017-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10388-023-01017-9

Keywords

Search

Navigation