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Peer-reviewedCC BY-NC-NDJournal of the anus, rectum and colon

Impact of the COVID-19 Pandemic on Inpatient Colorectal Cancer Treatment in Japan: An Interrupted Time Series Analysis Using a National Administrative Database.

  • Kensuke Nitta1
  • Makoto Okawara2
  • Jun Nagata1
  • Hiroto Sannomiya1
  • Atsuhiro Koga1
  • Yasuki Akiyama1
  • Masumi Yamauchi1
  • Yoshihisa Fujino3
  • Kiyohide Fushimi4
  • Shinya Matsuda3,5
  • Keiji Hirata1
5 affiliations
  1. 1Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
  2. 2Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
  3. 3Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
  4. 4Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan.
  5. 5Department of Nursing, Fukuoka International University of Health and Welfare, Fukuoka, Japan.
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Abstract

The COVID-19 pandemic disrupted elective endoscopy and non-urgent procedures, but its impact on inpatient colorectal cancer (CRC) treatment in Japan remains incompletely quantified. We conducted an interrupted time series analysis using the Diagnosis Procedure Combination (DPC) inpatient database. Eligible admissions were patients hospitalized between April 2018 and December 2021 with colorectal cancer codes from the International Classification of Diseases, 10th Revision (ICD-10; C18, C19, and C20) who underwent endoscopic submucosal dissection (ESD) or colorectal surgery. We excluded planned chemotherapy readmissions, recurrence cases, admissions with multiple non-ESD surgeries, and records with missing tumor-node-metastasis (TNM) information. Three periods were defined: Period 1 (Apr 2018-Apr 2020), Period 2 (May 2020-Apr 2021), and Period 3 (May 2021-Dec 2021). Monthly inpatient case volumes were modeled using segmented regression with Prais-Winsten estimation and seasonal adjustment. Of 276,458 eligible admissions, 260,919 were analyzed. At the start of Period 2, adjusted inpatient cases decreased significantly for ESD (-26%; 887 adjusted vs 1,194 predicted; p<0.001) and colectomy (-6%; 2,746 vs 2,928; p=0.043), whereas rectal resection/abdominoperineal resection showed no significant level change (-5%; p=0.189). In stage-stratified analyses limited to surgical resections, Stage I surgical volume decreased significantly at the start of Period 2 (-13%; p=0.010) with no clear reduction for Stages II-IV. In Japan, the early COVID-19 period was associated with short-term reductions in inpatient ESD and Stage I surgical volume, whereas surgical treatment volumes for more advanced disease showed no clear immediate reduction after the first emergency declaration. Because this was an administrative, inpatient-only analysis, the study does not directly assess diagnostic delays, stage migration, or downstream oncological outcomes.

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Cite

BibTeXRIS
BibTeX
@article{nitta2026impact,
  title = {{Impact of the COVID-19 Pandemic on Inpatient Colorectal Cancer Treatment in Japan: An Interrupted Time Series Analysis Using a National Administrative Database.}},
  author = {Kensuke Nitta and Makoto Okawara and Jun Nagata and Hiroto Sannomiya and Atsuhiro Koga and Yasuki Akiyama and Masumi Yamauchi and Yoshihisa Fujino and Kiyohide Fushimi and Shinya Matsuda and Keiji Hirata},
  journal = {Journal of the anus, rectum and colon},
  year = {2026},
  month = oct,
  doi = {10.23922/jarc.2026-010},
  url = {https://europepmc.org/article/MED/42952880},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Impact of the COVID-19 Pandemic on Inpatient Colorectal Cancer Treatment in Japan: An Interrupted Time Series Analysis Using a National Administrative Database.
AU  - Kensuke Nitta
AU  - Makoto Okawara
AU  - Jun Nagata
AU  - Hiroto Sannomiya
AU  - Atsuhiro Koga
AU  - Yasuki Akiyama
AU  - Masumi Yamauchi
AU  - Yoshihisa Fujino
AU  - Kiyohide Fushimi
AU  - Shinya Matsuda
AU  - Keiji Hirata
PY  - 2026
DA  - 2026/10/25
JO  - Journal of the anus, rectum and colon
DO  - 10.23922/jarc.2026-010
UR  - https://europepmc.org/article/MED/42952880
AB  - The COVID-19 pandemic disrupted elective endoscopy and non-urgent procedures, but its impact on inpatient colorectal cancer (CRC) treatment in Japan remains incompletely quantified. We conducted an interrupted time series analysis using the Diagnosis Procedure Combination (DPC) inpatient database. Eligible admissions were patients hospitalized between April 2018 and December 2021 with colorectal cancer codes from the International Classification of Diseases, 10th Revision (ICD-10; C18, C19, and C20) who underwent endoscopic submucosal dissection (ESD) or colorectal surgery. We excluded planned chemotherapy readmissions, recurrence cases, admissions with multiple non-ESD surgeries, and records with missing tumor-node-metastasis (TNM) information. Three periods were defined: Period 1 (Apr 2018-Apr 2020), Period 2 (May 2020-Apr 2021), and Period 3 (May 2021-Dec 2021). Monthly inpatient case volumes were modeled using segmented regression with Prais-Winsten estimation and seasonal adjustment. Of 276,458 eligible admissions, 260,919 were analyzed. At the start of Period 2, adjusted inpatient cases decreased significantly for ESD (-26%; 887 adjusted vs 1,194 predicted; p<0.001) and colectomy (-6%; 2,746 vs 2,928; p=0.043), whereas rectal resection/abdominoperineal resection showed no significant level change (-5%; p=0.189). In stage-stratified analyses limited to surgical resections, Stage I surgical volume decreased significantly at the start of Period 2 (-13%; p=0.010) with no clear reduction for Stages II-IV. In Japan, the early COVID-19 period was associated with short-term reductions in inpatient ESD and Stage I surgical volume, whereas surgical treatment volumes for more advanced disease showed no clear immediate reduction after the first emergency declaration. Because this was an administrative, inpatient-only analysis, the study does not directly assess diagnostic delays, stage migration, or downstream oncological outcomes.
SN  - 2432-3853
ER  -