Changes in surgical versus nonsurgical treatments for gastrointestinal cancers during the COVID-19 pandemic: a nationwide analysis in Japan

Purpose: To investigate the impact of the COVID-19 pandemic on the treatment landscape of gastrointestinal cancers in Japan, focusing on the use of nonsurgical treatments. Methods: We conducted a retrospective cohort study using a nationwide insurance database and analyzed data for esophageal, gastric, colon, rectal, liver, and pancreatic cancers treated between July, 2019 and December, 2020. We calculated the surgical-to-nonsurgical-treatment ratio (SNR) for each type of cancer during the pandemic and defined April, 2020 as the pandemic onset. We used regression discontinuity designs to assess changes in the SNR. Results: A total of 31,169 cases were included. At the pandemic onset, the SNR decreased for gastric, colon, rectal, and liver cancers, indicating a shift toward nonsurgical treatments. Thereafter, these cancers showed a gradual increase in the SNR, returning to pre-pandemic levels. Notably, esophageal cancer showed an increase in the SNR at the pandemic onset, whereas pancreatic cancer showed no significant changes during the study period. Conclusion: The COVID-19 pandemic led to a significant decrease in gastrointestinal cancer surgeries in Japan, prompting a temporary shift toward nonsurgical treatments. However, most cancers showed a gradual recovery in the SNR, highlighting the resilience of the healthcare system.