Aim Due to the overwhelming spread of SARS‐CoV‐2 and its disruption of the healthcare system, delays and reduced numbers were reported for colorectal cancer screening, colonoscopies, and surgery during the COVID‐19 pandemic. This multicenter retrospective study investigated the still poorly understood impact of the COVID‐19 pandemic on colorectal cancer treatment in Japan. Methods This study was organized by the Clinical Study Group of Osaka University, which comprised 32 major institutions in Osaka. We retrospectively analyzed the number of surgeries and colonoscopies performed and the characteristics of patients who underwent surgery for colorectal cancer between March 2019 and February 2021. We compared data collected before and during the COVID‐19 pandemic. We also assessed the methods used for detecting colorectal cancer, including fecal occult blood test, abdominal symptoms, and anemia. Results The COVID‐19 pandemic caused reductions in the annual numbers of surgeries (3569 vs 3198) and colonoscopies (67 622 vs 58 183) performed in the 2020 fiscal year, compared to the 2019 fiscal year. During the COVID‐19 pandemic, a significantly lower proportion of patients were treated for clinical stages ≤I (24.2% vs 26.9%; P = .011), compared to the proportion treated before the pandemic. Fecal occult blood tests for detecting colorectal cancer were used significantly less frequently during the COVID‐19 pandemic (26.2% vs 29.6%; P = .002). These trends were more significant in larger institutions. Conclusion The COVID‐19 pandemic reduced the number of colonoscopies and surgeries performed for colorectal cancer and hindered the detection of asymptomatic early‐stage cancers, and its impact varied by hospital size.
BACKGROUND: Previous randomized trials have assessed the effectiveness of triclosan-coated sutures in fascia closure after midline laparotomy in preventing surgical site infections (SSIs); however, available evidence remain inconclusive. We aimed to evaluate the effectiveness of triclosan-coated sutures in abdominal fascia closure to prevent postoperative SSIs. STUDY DESIGN: This study was a multicenter prospective trial conducted within 24 Japanese secondary and tertiary care centers and a propensity score (PS)–matched analysis. Patients 20 years of age or older who underwent elective surgery for colorectal cancer (CRC) were included. Between July 2016 and July 2019, 2,207 patients were prospectively enrolled into the triclosan-coated sutures or uncoated sutures groups. The per-protocol population comprised 2,195 patients. The PS matching was performed for 1,579 patients: 926 patients in the coated group and 653 patients in the uncoated group. The abdominal fascia after midline laparotomy was closed with triclosan-coated or uncoated sutures depending on group. The primary endpoint was the incidence of an SSI. Secondary endpoints were length of hospital stay and surgical complication rates. RESULTS: The recorded SSI rates were 4.2% in the triclosan-coated group and 6.74% in the uncoated suture group (p = 0.028). There were no serious adverse events in the groups. The final logistic regression model showed that several variables affected the occurrence of SSI. Our meta-analysis included six phase-III trials, and our study evaluated 4,797 patients. The results show a significant superiority of triclosan-coated sutures over uncoated suture material. CONCLUSION: Triclosan-coated sutures reduce the incidence of SSI after elective CRC surgery.
Here we report the guidelines for surgical intervention on vulnerable elderly patients with colorectal cancer. Appropriate preoperative and intraoperative evaluations are important when performing surgery to treat elderly patients with colorectal cancer. Preoperative risk factors including deterioration of physical and cognitive function, malnutrition, comorbidities, polypharmacy, and decreases in skeletal muscle mass are associated with increased rates of postoperative complications and death. Limiting intraoperative fluid administration, fluid management based on goal-directed therapy (GDT), and anesthesia-depth management using EEG monitoring to prevent hypothermia, cutaneous injury, muscular damage, neuropathy, and circulatory disturbance lead to reduced postoperative complications. However, there are insufficient data to establish a clinically significant association between risk factors and postoperative complications. Moreover, there are no data to determine if surgical intervention results in acceptable outcomes for vulnerable patients who undergo invasive surgery and who are poor candidates for standard treatment. In order to solve these problems, it is necessary to accumulate and analyze data based on comprehensive geriatric assessment (CGA).
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