Real-world evidence of safety and influence for lung cancer surgery under COVID-19 pandemic in Japan

Abstract

Background:The COVID-19 pandemic has affected the clinical practice of lung cancer surgery in Japan, but few studies have revealed the real situation of surgical practice for lung cancer in this country. This latest information will help us to decide the future direction of lung cancer surgery under pandemic circumstances. Methods:We collected data from patients with primary lung cancer who underwent thoracic surgery between 2018 and 2021. To investigate the impact of the COVID-19 pandemic on lung cancer surgery, we compared between 2018-2019 (prepandemic group) and 2020-2021 (pandemic group) in the respect of patient characteristics, pathological findings, and short-term outcome after lung cancer resection by Mann-Whitney and Fisher's exact tests. Moreover, the monthly number of surgeries for lung cancer in our institution during 2020-2021 was compared with the number of newly diagnosed COVID-19 patients in Japan by Spearman correlation analysis.Results: From 2018 through 2021, 936 patients with primary lung cancer underwent surgical intervention in our institute and were included in this study. The number of surgeries did not decrease in the pandemic group (n=443) compared with that in the prepandemic group (n=493). Tumor and invasive size in stage I which was measured by pathologist were significantly larger in the pandemic group than in the prepandemic group (tumor size: P=0.031, invasive size: P<0.001). In terms of postoperative short-term outcome, the median hospital stay was 6 days, 30-day mortality was 2, and morbidity was around 20% in both groups.Only one patient suffered from COVID-19 infection 5 months after right upper lobectomy. An increased ratio of newly diagnosed COVID-19 cases in Japan was negatively correlated with the number of surgeries for lung cancer in our institution in the next month (r=−0.393, P=0.007), although there was no correlation in the present or the month after next.Conclusions: Even during the COVID-19 pandemic period, lung cancer surgery could be performed safely and in a sustainable manner. However, pathological findings of lung cancer tended to be progressive in early-stage lung cancer.

Unveiling the Effects of the COVID-19 Pandemic on Lung Cancer Surgery

“…Regarding age and place of origin, no significant differences were reported among the three periods. These results are consistent with the literature, where in most studies, these variables did not significantly change throughout the pandemic [ 17 , 19 , 24 , 27 , 28 , 29 , 30 ]. However, Kirk et al [ 18 ] identified that patients undergoing surgery during the pandemic exhibited significantly higher ages ( p = 0.006) compared to the pre-pandemic period.…”

“…The decrease in the number of surgeries has been reported globally, with a hospital in the US also reporting a decrease of 50.4% compared to the previous period [ 17 ]. Significant differences have been evidenced in Queensland [ 18 ], as well as in countries such as Japan [ 19 ], Sweden [ 20 ], or England [ 21 ], where a significant decline in the number of surgical interventions performed has also been reported.…”

Impact of COVID-19 Pandemic on Advanced Non-small Cell Lung Cancer Treatment at a Japanese Hospital

“…Enlargement of primary lesions and progression of cancers discovered during the COVID-19 epidemic have been confirmed (15)(16)(17)(18)(19)(20)(21)(22). In breast cancer, for example, an increase in tumor size (15)(16)(17)(18)(19) and the of patients with advanced stage (17)(18)(19) has been reported.…”

“…In breast cancer, for example, an increase in tumor size (15)(16)(17)(18)(19) and the of patients with advanced stage (17)(18)(19) has been reported. In patients with resectable NSCLC, there were some reports of increased primary tumor diameter during the COVID-19 pandemic, although no differences were found in clinical stage (20)(21)(22). To our best knowledge, however, no study has assessed tumor size in advanced NSCLC during the COVID-19 pandemic and confirmed that they were diagnosed with greater size.…”

Evidence-based approach to determine risk of elective surgery during COVID-19 era

“…There were many difficult decisions that were made related to which types of surgeries were considered elective versus more urgent. The authors of the current study by Kato and colleagues described their experience during the pandemic and their outcomes in patients undergoing pulmonary resection for stage I lung cancers ( 1 ). In this editorial, we will review the current study and then give potential guidelines for future events.…”