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Feier CVI, Santoro RR, Faur AM, Muntean C, Olariu S. Assessing Changes in Colon Cancer Care during the COVID-19 Pandemic: A Four-Year Analysis at a Romanian University Hospital. J Clin Med 2023; 12:6558. [PMID: 37892695 PMCID: PMC10607165 DOI: 10.3390/jcm12206558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/08/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
This retrospective study investigates the impact of the COVID-19 pandemic on the surgical management of patients with colon cancer in a tertiary University Hospital in Timisoara, Romania. Data from 867 patients who underwent surgical interventions for this condition between 26 February 2019 and 25 February 2023 were meticulously analyzed to evaluate substantial shifts in the management and outcomes of these patients in comparison to the pre-pandemic era. The results reveal a substantial decrease in elective surgical procedures (p < 0.001) and a significant increase in emergency interventions (p < 0.001). However, postoperative mortality did not show significant variations. Of concern is the diagnosis of patients at more advanced stages of colon cancer, with a significant increase in Stage IV cases in the second year of the pandemic (p = 0.045). Average hospitalization durations recorded a significant decrease (p < 0.001) during the pandemic, and an inverse correlation between patient age and surgery duration was reported (p = 0.01, r = -0.088). This analysis provides a comprehensive perspective on how the pandemic has influenced the management of colon cancer, highlighting significant implications for the management and outcomes of these patients.
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Affiliation(s)
- Catalin Vladut Ionut Feier
- First Discipline of Surgery, Department X-Surgery, “Victor Babes” University of Medicine and Pharmacy, 2 E. Murgu Sq., 300041 Timisoara, Romania; (C.V.I.F.); (S.O.)
- First Surgery Clinic, “Pius Brinzeu” Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Rebecca Rosa Santoro
- Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Alaviana Monique Faur
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Calin Muntean
- Medical Informatics and Biostatistics, Department III-Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 2 E. Murgu Sq., 300041 Timisoara, Romania
| | - Sorin Olariu
- First Discipline of Surgery, Department X-Surgery, “Victor Babes” University of Medicine and Pharmacy, 2 E. Murgu Sq., 300041 Timisoara, Romania; (C.V.I.F.); (S.O.)
- First Surgery Clinic, “Pius Brinzeu” Clinical Emergency Hospital, 300723 Timisoara, Romania
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Wang QX, Wang J, Wu RK, Li YL, Yao CJ, Xie FJ, Xiong Q, Feng PM. The safety of digestive tract cancer surgery during COVID-19: A living systematic review and meta-analysis. Asian J Surg 2023; 46:4138-4151. [PMID: 36967345 PMCID: PMC10027963 DOI: 10.1016/j.asjsur.2023.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/23/2022] [Accepted: 03/08/2023] [Indexed: 03/24/2023] Open
Abstract
Surgery is the primary curative treatment of solid cancers. However, its safety has been compromised by the outbreak of COVID-19. Therefore, it is necessary to evaluate the safety of digestive tract cancer surgery in the context of COVID-19. We used the Review Manager software (v.5.4) and Stata software (version 16.0) for meta-analysis and statistical analysis. Sixteen retrospective studies involving 17,077 patients met the inclusion criteria. The data indicates that performing digestive tract cancer surgery during the COVID-19 pandemic led to increased blood loss(MD = -11.31, 95%CI:-21.43 to -1.20, P = 0.03), but did not increase postoperative complications(OR = 1.03, 95%CI:0.78 to1.35, P = 0 0.86), anastomotic leakage (OR = 0.96, 95%CI:0.52 to1.77, P = 0 0.89), postoperative mortality (OR = 0.65, 95%CI:0.40 to1.07, P = 0 0.09), number of transfusions (OR = 0.74, 95%CI:0.30 to 1.80, P = 0.51), number of patients requiring ICU care(OR = 1.37, 95%CI:0.90 to 2.07, P = 0.14), postoperative 30-d readmission (OR = 0.94, 95%CI:0.82 to 1.07, P = 0 0.33), total hospital stay (MD = 0.11, 95%CI:-2.37 to 2.59, P = 0.93), preoperative waiting time(MD = - 0.78, 95%CI:-2.34 to 0.79, P = 0.33), postoperative hospital stay(MD = - 0.44, 95%CI:-1.61 to 0.74, P = 0.47), total operation time(MD = -12.99, 95%CI:-28.00 to 2.02, P = 0.09) and postoperative ICU stay (MD = - 0.02, 95%CI:-0.62 to 0.57, P = 0.94). Digestive tract cancer surgery can be safely performed during the COVID-19.
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Affiliation(s)
- Qiu-Xiang Wang
- Department of Traditional Chinese Medicine, The Central Hospital of Guangyuan City, Sichuan Province, China; Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Juan Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Rui-Ke Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yi-Lin Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Cheng-Jiao Yao
- Department of Geriatrics of the Affiliated Hospital, North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Feng-Jiao Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Qin Xiong
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Pei-Min Feng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China.
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Wang Q, Wu R, Wang J, Li Y, Xiong Q, Xie F, Feng P. The safety of colorectal cancer surgery during the COVID-19: a systematic review and meta-analysis. Front Oncol 2023; 13:1163333. [PMID: 37529694 PMCID: PMC10390253 DOI: 10.3389/fonc.2023.1163333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/21/2023] [Indexed: 08/03/2023] Open
Abstract
Background The ongoing coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented pressure on the healthcare systems. This study evaluated the safety of colorectal cancer (CRC) surgery during the COVID-19 pandemic. Methods A systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO ID: CRD 42022327968). Relevant articles were systematically searched in the PubMed, Embase, Web of Science, and Cochrane databases. The postoperative complications, anastomotic leakage, postoperative mortality, 30-day readmission, tumor stage, total hospitalization, postoperative hospitalization, preoperative waiting, operation time, and hospitalization in the intensive care unit (ICU) were compared between the pre-pandemic and during the COVID-19 pandemic periods. Results Among the identified 561 articles, 12 met the inclusion criteria. The data indicated that preoperative waiting time related to CRC surgery was higher during the COVID-19 pandemic (MD, 0.99; 95%CI, 0.71-1.28; p < 0.00001). A similar trend was observed for the total operative time (MD, 25.07; 95%CI, 11.14-39.00; p =0.0004), and on T4 tumor stage during the pandemic (OR, 1.77; 95%CI, 1.22-2.59; p=0.003). However, there was no difference in the postoperative complications, postoperative 90-day mortality, anastomotic leakage, and 30-day readmission times between pre-COVID-19 pandemic and during the COVID-19 pandemic periods. Furthermore, there was no difference in the total hospitalization time, postoperative hospitalization time, and hospitalization time in ICU related to CRC surgery before and during the COVID-19 pandemic. Conclusion The COVID-19 pandemic did not affect the safety of CRC surgery. The operation of CRC during the COVID-19 pandemic did not increase postoperative complications, postoperative 90-day mortality, anastomotic leakage, 30-day readmission, the total hospitalization time, postoperative hospitalization time, and postoperative ICU hospitalization time. However, the operation of CRC during COVID-19 pandemic increased T4 of tumor stage during the COVID-19 pandemic. Additionally, the preoperative waiting and operation times were longer during the COVID-19 pandemic. This provides a reference for making CRC surgical strategy in the future. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022327968.
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Affiliation(s)
- Qiuxiang Wang
- Department of Gastroenterology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Department of Traditional Chinese Medicine, The Central Hospital of Guangyuan City, Sichuan, China
| | - Ruike Wu
- Department of Gastroenterology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Juan Wang
- Department of Gastroenterology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yilin Li
- Department of Gastroenterology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qin Xiong
- Department of Gastroenterology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fengjiao Xie
- Department of Gastroenterology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Peimin Feng
- Department of Gastroenterology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Cano-Valderrama O, Sánchez-Santos R, Vigorita V, Paniagua M, Flores E, Garrido L, Facal C, Ruano A, San-Ildefonso A, Moncada E. Has the COVID-19 pandemic changed the clinical picture and tumour stage at the time of presentation of patients with colorectal cancer? A retrospective cohort study. Cir Esp 2023; 101:90-96. [PMID: 35169328 PMCID: PMC8831139 DOI: 10.1016/j.ciresp.2022.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/06/2022] [Indexed: 02/04/2023]
Abstract
Introduction Treatment of patients with Coronavirus Disease 2019 (COVID-19) has affected the management of patients with colorectal cancer (CRC). The aim of this study was to compare the diagnosis delay, symptoms, and stage of patients with CRC during the pandemic with a control cohort. Material and methods Patients referred to the CRC multidisciplinary team between September 2019 and January 2020 (cohort 1, control group) were compared with those who presented between September 2020 and March 2021 (cohort 2, pandemic group). Results 389 patients were included, 169 in cohort 1 and 220 in cohort 2. No differences were observed in the main characteristics of the patients. CRC screening and anaemia were the most common causes leading to the diagnosis of the tumour in cohort 1 and 2, respectively (p < 0.001). Diagnostic and therapeutic delay was longer in cohort 2 [6.4 (95% CI 5.8-6.9) vs. 4.8 (95% CI 4.3-5.3) months, p < 0.001]. More patients required non-elective treatment in the pandemic cohort (15.5% vs. 9.5%, p = 0.080). The tumour stage was more advanced in patients in cohort 2 [positive nodes in 52.3% vs. 36.7% (p = 0.002), and metastatic disease in 23.6% vs. 16.6% (p = 0.087)]. Conclusion CRC patients in the pandemic cohort had a longer diagnostic and therapeutic delay and less patients were diagnosed because of CRC screening. In addition, patients with CRC during the pandemic needed non-elective treatment more frequently than patients in the control cohort, and their tumour stage tended to be more advanced.
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Affiliation(s)
- Oscar Cano-Valderrama
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain,Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain,Corresponding author
| | - Raquel Sánchez-Santos
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain,Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Vincenzo Vigorita
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain,Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Marta Paniagua
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain,Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Erene Flores
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain,Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Lucia Garrido
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain,Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Cristina Facal
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain,Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Alejandro Ruano
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain,Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Alberto San-Ildefonso
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain,Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Enrique Moncada
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain,Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
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Cano-Valderrama O, Sánchez-Santos R, Vigorita V, Paniagua M, Flores E, Garrido L, Facal C, Ruano A, San-Ildefonso A, Moncada E. Has the COVID-19 pandemic changed the clinical picture and tumour stage at the time of presentation of patients with colorectal cancer? A retrospective cohort study. Cir Esp 2023; 101:90-96. [PMID: 36774002 PMCID: PMC9909381 DOI: 10.1016/j.cireng.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/06/2022] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Treatment of patients with Coronavirus Disease 2019 (COVID-19) has affected the management of patients with colorectal cancer (CRC). The aim of this study was to compare the diagnosis delay, symptoms, and stage of patients with CRC during the pandemic with a control cohort. MATERIAL AND METHODS Patients referred to the CRC multidisciplinary team between September 2019 and January 2020 (cohort 1, control group) were compared with those who presented between September 2020 and March 2021 (cohort 2, pandemic group). RESULTS 389 patients were included, 169 in cohort 1 and 220 in cohort 2. No differences were observed in the main characteristics of the patients. CRC screening and anaemia were the most common causes leading to the diagnosis of the tumour in cohort 1 and 2, respectively (p<0.001). Diagnostic and therapeutic delay was longer in cohort 2 [6.4 (95% CI 5.8-6.9) vs. 4.8 (95% CI 4.3-5.3) months, p<0.001]. More patients required non-elective treatment in the pandemic cohort (15.5% vs. 9.5%, p=0.080). The tumour stage was more advanced in patients in cohort 2 [positive nodes in 52.3% vs. 36.7% (p=0.002), and metastatic disease in 23.6% vs. 16.6% (p=0.087)]. CONCLUSION CRC patients in the pandemic cohort had a longer diagnostic and therapeutic delay and less patients were diagnosed because of CRC screening. In addition, patients with CRC during the pandemic needed non-elective treatment more frequently than patients in the control cohort, and their tumour stage tended to be more advanced.
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Affiliation(s)
- Oscar Cano-Valderrama
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain.
| | - Raquel Sánchez-Santos
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Vincenzo Vigorita
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Marta Paniagua
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Erene Flores
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Lucia Garrido
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Cristina Facal
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Alejandro Ruano
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Alberto San-Ildefonso
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Enrique Moncada
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
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Tang G, Pi F, Tao J, Wei Z. Impact of the COVID-19 pandemic on surgical outcomes in patients undergoing colorectal cancer surgery: A retrospective study and meta-analysis of data from 11,082 participants. Front Public Health 2022; 10:907571. [PMID: 36249184 PMCID: PMC9556652 DOI: 10.3389/fpubh.2022.907571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/14/2022] [Indexed: 01/22/2023] Open
Abstract
Background The COVID-19 pandemic is affecting the care of patients with colorectal cancer worldwide, resulting in the postponement of many colorectal cancer surgeries. However, the effectiveness and safety of performing colorectal cancer surgery during the COVID-19 pandemic is unknown. This study evaluated the impact of the COVID-19 pandemic on surgical outcomes in patients undergoing colorectal cancer surgery. Methods We retrospectively identified patients undergoing colorectal cancer surgery in January 21, 2019, to April 1, 2019, vs. January 21, 2020, to April 1, 2020. Data regarding perioperative outcomes (postoperative complications, conversion rate, duration of surgery, intraoperative blood loss, transfusion, reoperation, intensive care, histological examination, morbidity, and length of hospital stay) were retrieved and compared between the two cohorts. A meta-analysis of 14 studies was also conducted to assess the impact of the COVID-19 pandemic on surgical outcomes in patients undergoing colorectal cancer surgery. Results The sample included 68 patients who underwent surgery in 2020 and 136 patients who underwent surgery in 2019. No patient was converted from laparoscopy to laparotomy or required reoperation. R0 resection was completed in all patients in both groups. There was no significant difference in postoperative complications (p = 0.508), duration of surgery (p = 0.519), intraoperative blood loss (p = 0.148), transfusion (0.217), intensive care (p = 0.379), mean lymph node yield (p = 0.205), vascular positivity rate (p = 0.273), nerve invasion rate (p = 0.713), anastomosis leak rate (p = 1), morbidity (p = 0.478), and length of hospital stay (p = 0.623) between the two groups. The meta-analysis also showed no significant difference in short-term outcomes between the two groups. Conclusions Our study shows that the COVID-19 pandemic has not led to a deterioration in the surgical outcomes of colorectal cancer surgery or reduction in the quality of cancer removal. Therefore, we do not recommend postponing elective colorectal cancer surgery during the COVID-19 pandemic.
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Affiliation(s)
- Gang Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Pi
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Tao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengqiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Zhengqiang Wei
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Impact of the COVID-19 Pandemic on the Elective Surgery for Colorectal Cancer: Lessons to Be Learned. Medicina (B Aires) 2022; 58:medicina58101322. [PMID: 36295483 PMCID: PMC9609708 DOI: 10.3390/medicina58101322] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 01/19/2023] Open
Abstract
The review investigates the impact of the COVID-19 pandemic on the elective surgical treatment of patients diagnosed with colorectal cancer, and the modifications of the duration of hospital stay scheduled for the surgery. Most of the studies included in our analysis showed a decrease in the number of elective surgical procedures applied to patients with colorectal cancer, varying from 14% to 70% worldwide. We have also observed a significant shortening of the hospital stay in most of the cases, associated with a longer waiting time until hospital admission. In the end, we have performed a synthesis of all the valuable data and advice gathered from real life observations, proposing a strategy to deal with the pandemic and with the large number of cancer patients accumulated during these difficult times.
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Okuyan GÇ, Yıldırım M. The effect of the COVID-19 pandemic on the outcomes of surgically treated colorectal diseases: a retrospective cohort study. Ann Surg Treat Res 2022; 103:104-111. [PMID: 36017140 PMCID: PMC9365639 DOI: 10.4174/astr.2022.103.2.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/03/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose The objective of this study is to evaluate the effect of the coronavirus disease 2019 (COVID-19) pandemic on elective and emergent colorectal surgical practice. Methods The population of this retrospective observational study consisted of all consecutive patients who underwent emergent or elective colorectal surgery between March 2019 and March 2021. The patients were divided into 2 groups: the prepandemic group who were treated between March 2019 and March 10, 2020, and the pandemic group who were treated between March 11, 2020 and March 2021. The rate of emergent operations was the primary outcome. The groups were compared based on the frequency of operations, distribution of tumoral features in malignant cases, and 90th-day mortality rates. Results There were 180 and 121 patients in the prepandemic and pandemic groups, respectively. There were significantly more patients of the American Society of Anesthesiologists physical status stage IV with comorbidity in the pandemic group than in the prepandemic group (P = 0.016 and P < 0.001, respectively). The rate of emergent operations was significantly higher in the pandemic group than in the prepandemic group (49.6% vs. 26.7%, P < 0.001). There were significantly more patients who received non-resectional surgery in the pandemic group than in the prepandemic group (P = 0.002). Additionally, there were significantly more patients without resection among patients with a defunctioning stoma (P = 0.001). The length of hospital stay (LoS) was significantly shorter in the pandemic group than in the prepandemic group (P = 0.039). On the other hand, the mortality rate was significantly higher in the pandemic group than in the prepandemic group (15.7% vs. 6.1%, P = 0.011). Conclusion The study findings suggested that the COVID-19 pandemic adversely affected colorectal surgical practices, resulting in more frequent emergent operations, non-resectional procedures with stoma formation, and higher mortality rates.
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Affiliation(s)
- Gülten Çiçek Okuyan
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Melih Yıldırım
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
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Kim YI, Park IJ. Surgical safety in the COVID-19 era: present and future considerations. Ann Surg Treat Res 2022; 102:295-305. [PMID: 35800996 PMCID: PMC9204020 DOI: 10.4174/astr.2022.102.6.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
The impacts of coronavirus disease 2019 (COVID-19) have been globally paradigm shifting in all aspects. Surgeons have experienced unprecedented changes regarding operation schedules, preparations before surgery, and the precautions needed both during and after surgery. Many medical centers simultaneously reported a decrease in their numbers of surgeries, whether they were elective or emergent, or for cancerous or benign resections. However, accumulated surgical outcomes from the last 2 years of experience presented postoperative morbidity and mortality data that were comparable to the pre-pandemic era, whether in elective or urgent settings. Although COVID-19 showed a significant association with postoperative morbidity and mortality, the majority of noninfected patients could be treated successfully with stringent mitigation protocols. Initially recommended to be avoided at the start of the pandemic, minimally invasive surgery seems to be safe and feasible according to reported surgical outcomes. Numerous sets of guidelines have now been produced from medical societies and adhering to the basic precautions has been found to be practicable. It is crucial that health care systems and surgical staff remain vigilant and attentive to the ever-changing situation in this pandemic in order to provide optimal medical support to their patients.
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Affiliation(s)
- Young Il Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Mazidimoradi A, Hadavandsiri F, Momenimovahed Z, Salehiniya H. Impact of the COVID-19 Pandemic on Colorectal Cancer Diagnosis and Treatment: a Systematic Review. J Gastrointest Cancer 2021; 54:171-187. [PMID: 34843058 PMCID: PMC8628028 DOI: 10.1007/s12029-021-00752-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 02/06/2023]
Abstract
Background Following the official announcement of the COVID-19 pandemic by the World Health Organization (WHO) in March 2020 and decreased activity of healthcare systems, relocation of resources, and the possible reluctance of patients to seek medical help, colorectal cancer patients were exposed to significant risks. Given that colon cancer is the third most common cancer and the second deadliest cancer in the world, its timely diagnosis and treatment are necessary to reduce costs and improve quality of life and patient survival. The aim of this study was to investigate the effects of COVID-19 pandemic on the diagnosis and treatment of colorectal cancer. Methods and Materials A comprehensive search performed on June 2021 in various databases, including Medline, Web of Science, and Scopus. Keywords such as “diagnosis,” “treatment,” “coronavirus disease-19,” “COVID-19,” “coronavirus disease,” “SARS-CoV-2 infection,” “SARS-CoV-2,” “2019-nCoV,” “coronavirus, 2019 novel,” “SARS-CoV-2 virus,” severe acute respiratory syndrome coronavirus 2,” “COVID-19,” “COVID-19, coronavirus disease 19,” “SARS coronavirus 2,” “colorectal neoplasm,” and “colorectal cancer “ was used individually or a combination of these words. All retrieved articles were entered into a database on EndNote X7. Then, studies were first selected by title and then by abstract, and at the end, full texts were investigated. Results Of the 850 studies, 43 were identified as eligible. According to studies, the diagnosis of colorectal cancer and the number of diagnostic procedures have decreased. Emergency visits due to obstruction or perforation of the large intestine or in advanced stages of cancer have increased, and a delay in the diagnosis of colorectal cancer has reported from 5.4 to 26%. Treatment of colorectal cancer has also decreased significantly or has been delayed, interrupted, or stopped. This reduction and delay have been observed in all treatments, including surgery, chemotherapy, and long-term radiation therapy; only cases of emergency surgery and short-term radiotherapy has increased. The waiting time for hospitalization and the length of hospital stay after surgery has been reported to be higher. Changes in patients’ treatment plans and complete to partial cessation of hospitals activities—that provided treatment services—were reported. Conclusion According to the reduction in the diagnosis and treatment of colorectal cancer due to the COVID-19 pandemic, compensating for the reduction and preventing the continuation of this declining trend, requires serious and effective interventions to prevent its subsequent consequences, including referrals of people with advanced stages and emergency conditions, increasing treatment costs and reducing the quality of life and patients survival.
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Affiliation(s)
| | - Fatemeh Hadavandsiri
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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Tan XB, Peng D, Liu XY, Cheng Y. The safety of on gastrointestinal cancer surgery during COVID-19: A meta-analysis. Asian J Surg 2021; 44:1127-1128. [PMID: 34147333 PMCID: PMC8193022 DOI: 10.1016/j.asjsur.2021.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Xiao-Bo Tan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yong Cheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Choi JY, Park IJ, Lee HG, Cho E, Kim YI, Kim CW, Yoon YS, Lim SB, Yu CS, Kim JC. Impact of the COVID-19 Pandemic on Surgical Treatment Patterns for Colorectal Cancer in a Tertiary Medical Facility in Korea. Cancers (Basel) 2021; 13:cancers13092221. [PMID: 34066390 PMCID: PMC8125443 DOI: 10.3390/cancers13092221] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The COVID-19 pandemic is threatening to public health, including malignant disease. Fear of viral infection has influenced the diagnosis and treatment of colorectal cancer and may result in impairment of surgical and oncologic outcomes. Therefore, we need to analyze the influence of COVID-19 on surgical outcomes of colorectal cancer and provide guidance on proper diagnosis and treatment, including public messaging regarding appropriate healthcare. Abstract Because of their reluctance to visit the hospital due to concerns about contracting coronavirus disease 2019 (COVID-19), patients with colorectal cancer have been affected by delays in care during the pandemic. This study assessed the effects of the pandemic on the clinical characteristics and surgical treatment patterns of colorectal cancer patients at a tertiary medical facility in Korea. Patients who underwent colorectal cancer surgery at our institution between March and September 2020 were analyzed. Clinicopathological and treatment characteristics were compared with those of patients who underwent surgery in 2018 and 2019. The patients who did not undergo tumor resection (4.1% vs. 1.8%, p < 0.001) and who received neoadjuvant treatment (16.7% vs. 14.7%, p = 0.039) were significantly higher during the COVID period. The minimally invasive approach was performed less during the COVID period (81.2% vs. 88%, p < 0.001). More patients in the COVID period required combined resection of organs adjacent to the tumor (4.8% vs. 2.8%, p = 0.017). Surgical aggressiveness, as shown by the proportion of patients undergoing minimally invasive surgery and adjacent organ resection, was significantly influenced by the pandemic. In addition, resectability decreased during the COVID period. These characteristics will likely influence long-term oncological outcomes, indicating the need for long-term monitoring of this cohort.
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Affiliation(s)
- Ju Yeon Choi
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - In Ja Park
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
- Correspondence: ; Tel.: +82-2-3010-3937
| | - Hyun Gu Lee
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Eunhae Cho
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Young Il Kim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Chan Wook Kim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Yong Sik Yoon
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Seok-Byung Lim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Chang Sik Yu
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Jin Cheon Kim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
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