Impact of the COVID-19 pandemic on gastric surgery in Japan: A nationwide study using interrupted time-series analyses

Background and Aim: Changes in the number of surgeries for gastric cancer during the coronavirus disease 2019 (COVID-19) pandemic have been reported, but data are insufficient to understand the impact at the national level. This study aimed to determine the impact of the COVID-19 pandemic on gastric surgery in Japan. Methods: Insurance claims data registered from January 2015 to January 2021 were used. Changes in the number of endoscopic resections and gastrectomies for gastric cancer were estimated using an interrupted time-series analysis. Results: The number of endoscopic resections significantly decreased in July 2020 (−1565; 95% confidence interval [CI]: −2022, −1108) and January 2021 (−539; 95% CI: −970, −109), and the number of laparoscopic surgeries significantly decreased in July 2020 (−795; 95% CI: −1097, −492), October 2020 (−313; 95% CI: −606, −19), and January 2021 (−507; 95% CI: −935, −78). Meanwhile, the number of open gastrectomies remained unchanged, and the number of robot-assisted gastrectomies steadily increased since their coverage by public health insurance in April 2018. Conclusions: The decreased number of endoscopic resections and laparoscopic surgeries in Japan suggests a decline in early-stage gastric cancer diagnosis, likely due to the suspension of gastric cancer screening and diagnostic testing during the pandemic. Meanwhile, the number of open and robot-assisted gastrectomies remained unchanged and increased, respectively, indicating that these applications were not affected by the pandemic-related medical crisis. These findings highlight that procedures for cancer diagnosis, including screening, should still be provided during pandemics.