How should colorectal surgeons practice during the COVID-19 epidemic? A retrospective single-centre analysis based on real-world data from China

Impact of COVID-19 Pandemic on the Clinical and Pathologic Characteristics of Colorectal Cancer: A Retrospective Multicenter Study in South Korea

Purpose

The COVID-19 pandemic has influenced various aspects of colorectal cancer (CRC) patient care, including diagnosis, treatment, and outcomes. This study assesses the pandemic's impact on CRC patients.

Methods

We performed a retrospective analysis of medical records for CRC patients who underwent surgery at five hospitals affiliated with Hallym University from January 2017 to December 2022. Patients were divided into two groups: the pre-COVID group (2017-2019) and the COVID group (2020-2022).

Results

Among 2038 patients, 987 (48.4%) were in the pre-COVID group, and 1051 (51.6%) were in the COVID group. The COVID group had more patients with two or more comorbidities (P < 0.001) and a higher incidence of rectal cancer (P = 0.010). While the rates of laparoscopic surgeries were similar, the COVID group had increased emergency surgeries (P = 0.005) and diversion procedures (P = 0.002). Additionally, the COVID group faced more overall complications (P < 0.001) and severe complications (Grade III-V, P = 0.004). There was a rise in lymphovascular invasion (P < 0.001) and T4 stage tumors (P < 0.001) within the COVID group. Despite these differences, both groups had similar 2-year overall survival rates (P = 0.409).

Conclusion

Although patients treated during the COVID period experienced more frequent stoma formation, complications, and adverse prognostic factors, there were no differences in short-term oncologic outcomes, which was likely due to the follow-up period being insufficient to detect differences in OS.

Assessing Changes in Colon Cancer Care during the COVID-19 Pandemic: A Four-Year Analysis at a Romanian University Hospital

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.

Impact of the COVID-19 Pandemic on Colorectal Cancer Diagnosis and Treatment: a Systematic Review

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.

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

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.

Impact of the COVID-19 Pandemic on the Elective Surgery for Colorectal Cancer: Lessons to Be Learned

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.

COVID-19 pandemisinin inguinal herni cerrahi tedavisi üzerindeki etkisi: Tek bir merkezde retrospektif bir çalışma

Aim: In this study, we aimed to examine the effect of the COVID 19 pandemic on the number, complication rates and epidemic characteristics of patients operated with the diagnosis of inguinal hernia in our institute. Methods: We analyzed all patients who underwent inguinal hernia operation in Trakya University Faculty of Medicine, Dept of General Surgery, between March 11, 2019, and March 11, 2020, and compared them with the cases between March 11, 2020, and March 11, 2021, retrospectively. Percentages, mean, standard deviation, median and interquartile range were used as the descriptive statistics. Mann-Whitney U test was used for the variations which are contrary to the normal distribution range in the comparison of two groups. The relations between qualitative variations were studied by the Pearson Chi-Square test and Fisher's Exact test. Significant value was determined as 0.05 for all statistical analyses. Results: Between March 11, 2019, and 2020, 65 patients were operated on (Group 1), and 26 patients between March 11, 2020, and 2021 (Group 2). The percentage of female patients was significantly higher in Group 2 (4.6% in Group 1, 23.1% in Group 2, p=0.008) and there was a statistically significant increase in the rate of incarceration and strangulation in Group 2 (44.6% in Group 1, 84.6% in Group 2, p=0.001). Conclusions: During the COVID-19 pandemic the incarceration and strangulation rate was higher. The increase in complication rates can be attributed to the relative decrease in elective surgeries or the increase in the number of female patients admitted during the COVID period.

The Spill-Over Impact of the Novel Coronavirus-19 Pandemic on Medical Care and Disease Outcomes in Non-communicable Diseases: A Narrative Review

Objectives: The coronavirus-19 (COVID-19) pandemic has claimed more than 5 million lives worldwide by November 2021. Implementation of lockdown measures, reallocation of medical resources, compounded by the reluctance to seek help, makes it exceptionally challenging for people with non-communicable diseases (NCD) to manage their diseases. This review evaluates the spill-over impact of the COVID-19 pandemic on people with NCDs including cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory disease, chronic kidney disease, dementia, mental health disorders, and musculoskeletal disorders. Methods: Literature published in English was identified from PubMed and medRxiv from January 1, 2019 to November 30, 2020. A total of 119 articles were selected from 6,546 publications found. Results: The reduction of in-person care, screening procedures, delays in diagnosis, treatment, and social distancing policies have unanimously led to undesirable impacts on both physical and psychological health of NCD patients. This is projected to contribute to more excess deaths in the future. Conclusion: The spill-over impact of COVID-19 on patients with NCD is just beginning to unravel, extra efforts must be taken for planning the resumption of NCD healthcare services post-pandemic.

Impact of the early phase of the COVID pandemic on cancer treatment delivery and the quality of cancer care: a scoping review and conceptual model

Background

The disruption of health services due coronavirus disease (COVID) is expected to dramatically alter cancer care; however, the implications for care quality and outcomes remain poorly understood. We undertook a scoping review to evaluate what is known in the literature about how cancer treatment has been modified as a result of the COVID pandemic in patients receiving treatment for solid tumours, and what domains of quality of care are most impacted.

Methods

Citations were retrieved from MEDLINE and EMBASE (1 Jan 2019 to 28 Oct 2020), utilizing search terms grouped by key concept (oncology, treatment, treatment modifications and COVID). Articles were excluded if they dealt exclusively with management of COVID-positive patients, modifications to cancer screening, diagnosis or supportive care, or were not in English. Articles reporting on guidelines, consensus statements, recommendations, literature reviews, simulations or predictive models, or opinions in the absence of accompanying information on experience with treatment modifications in practice were excluded. Treatment modifications derived from the literature were stratified by modality (surgery, systemic therapy and radiotherapy) and thematically grouped. To understand what areas of quality were most impacted, modifications were mapped against the Institute of Medicine’s quality domains. Where reported, barriers and facilitators were abstracted and thematically grouped to understand drivers of treatment modifications. Findings were synthesized into a logic model to conceptualize the inter-relationships between different modifications, as well as their downstream impacts on outcomes.

Results

In the 87 retained articles, reductions in outpatients visits (26.4%), and delays/deferrals were commonly reported across all treatment modalities (surgery: 50%; systemic therapy: 55.8%; radiotherapy: 56.7%); as were reductions in surgical capacity (57.1%), alternate systemic regimens with longer treatment intervals or use of oral agents (19.2%), and the use of hypofractionated radiotherapy regimens (40.0%). Delivery of effective, timely and equitable care were the quality domains found to be most impacted. The most commonly reported facilitator of maintaining cancer care delivery levels was the shift to virtual models of care (62.1%), while patient-initiated deferrals and cancellations (34.8%), often due to fear of contracting COVID (60.9%), was a commonly reported barrier.

Conclusions

As it will take a considerable amount of time for the cancer system to resume capacity and adjust models of care in response to the pandemic, these treatment delays and modifications will likely be prolonged, and will negatively impact quality of care and patient outcomes.

Acute complex appendicitis during the COVID-19 epidemic: A single-institution retrospective analysis based on real-world data

Objectives

To investigate the influence of Coronavirus Disease 2019 on incidence of acute complex appendicitis and management of acute appendicitis.

Methods

Patients undergoing acute appendicitis surgery in a single center during the COVID-19 epidemic from January to September 2020 and patients from January to September 2019 were taken as the epidemic group and control group respectively. The clinical characteristics and surgical pathological information were compared between the two groups. The primary outcome measure was complex appendicitis.

Results

A total of 235 patients were included in the study, containing 106 in the epidemic group and 129 in the control group. The patients in the epidemic group had a significantly longer interval from the onset of symptoms to registration (37.92 h vs 24.57 h, P = 0.028), from registration to admission (18.69 h vs 8.04 h, P < 0.001), and from admission to surgery (7.23 h vs 6.52 h, P = 0.016). The epidemic group had a higher incidence of suppurative appendicitis (86.8% vs 76.0%, P = 0.036) and a higher incidence of complex appendicitis (35.8% vs 19.4%, P = 0.005).

Conclusion

Higher incidence of acute complex appendicitis seemed to occur during COVID-19 outbreak.

Delays and Disruptions in Cancer Health Care Due to COVID-19 Pandemic: Systematic Review

PURPOSE

There has been noteworthy concern about the impact of COVID-19 pandemic on health services including the management of cancer. In addition to being considered at higher risk for worse outcomes from COVID-19, people with cancer may also experience disruptions or delays in health services. This systematic review aimed to identify the delays and disruptions to cancer services globally.

METHODS

This is a systematic review with a comprehensive search including specific and general databases. We considered any observational longitudinal and cross-sectional study design. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the studies was assessed by specific tools. The delays and disruptions identified were categorized, and their frequency was presented.

RESULTS

Among the 62 studies identified, none exhibited high methodological quality. The most frequent determinants for disruptions were provider- or system-related, mainly because of the reduction in service availability. The studies identified 38 different categories of delays and disruptions with impact on treatment, diagnosis, or general health service. Delays or disruptions most investigated included reduction in routine activity of cancer services and number of cancer surgeries; delay in radiotherapy; and delay, reschedule, or cancellation of outpatient visits. Interruptions and disruptions largely affected facilities (up to 77.5%), supply chain (up to 79%), and personnel availability (up to 60%).

CONCLUSION

The remarkable frequency of delays and disruptions in health care mostly related to the reduction of the COVID-19 burden unintentionally posed a major risk on cancer care worldwide. Strategies can be proposed not only to mitigate the main delays and disruptions but also to standardize their measurement and reporting. As a high number of publications continuously are being published, it is critical to harmonize the upcoming reports and constantly update this review.