Journal of Cardiothoracic Surgery | 2021
Effect of the coronavirus disease pandemic on bronchoscopic diagnosis of lung cancer in a provincial city in Japan
Abstract
Since its detection in Japan in January 2020, the coronavirus disease (COVID-19) has rapidly spread. Strict mitigating measures helped end the first wave of the outbreak. However, there is increasing concern of a second wave of infection. As effective vaccines and drugs for COVID-19 are still underway, long-term management plans are necessary to prevent the spread of infection. Moreover, “new clinical practice models” are necessary to accommodate both COVID-19 and nonCOVID-19 patients. Recently, the incidence of lung cancer has steadily increased in Japan and the world [1]. Bronchoscopy is an important diagnostic method for lung cancer; however, performing bronchoscopy is challenging considering the threat of nosocomial infections during the COVID-19 pandemic [2, 3]. Similar to other coronavirus diseases, COVID-19 is mostly transmitted via droplets and contact [4]. Additionally, studies suggest aerosol transmission during specific medical procedures [5]. In particular, if a person is exposed to elevated aerosol concentrations in closed spaces such as bronchoscopy rooms, aerosol transmission of COVID-19 may occur causing nosocomial infection [6]. In this study, we compared characteristics of lung cancer patients who underwent surgery at our hospital from March to August 2020 with those of such patients from previous years (March to August 2017 to 2019) to examine the effects of the pandemic on bronchoscopic diagnosis of lung cancer. At our hospital, a core facility in the provincial city of Yamanashi, we perform surgeries for 160–170 lung cancer cases yearly. During the pandemic, the number of lung cancer patients who underwent surgery (n = 89) from March to August 2020 was comparable with that of previous years (Table 1) and did not decrease even though computed tomography (CT) screening was not routinely performed and the number of medical examinations substantially reduced. A possible reason could be that several local smaller-sized hospitals refrained from providing certain health care services such as lung cancer surgery during the pandemic. On comparing the characteristics of stage I-II lung cancer patients between 2017 and 2019 and 2020, no significant differences in age or sex were found; however, the number of bronchoscopy procedures and endoscopic diagnoses of lung cancer were significantly lower in 2020 (Table 1). We do not now perform CT-guided biopsy at our hospital despite its high diagnostic accuracy because of the potential risk of air embolism and dissemination [7]. Therefore, the number of patients who underwent surgery without a preoperative definitive diagnosis substantially increased during the pandemic in 2020. Additionally, among these patients, the number of those undergoing rapid pathological examinations during surgery significantly increased. Comparing the data with those from 2017 to 2019 revealed no significant changes in surgical procedures or histology. However, the number of patients with advanced stage disease (IIA