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Manzella A, Ecker BL, Eskander MF, Grandhi MS, In H, Kravchenko T, Langan RC, Kennedy T, Alexander HR, Beninato T, Pitt HA. Operative trends for pancreatic and hepatic malignancies during the COVID-19 pandemic. Surgery 2024; 176:364-370. [PMID: 38582733 DOI: 10.1016/j.surg.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted routine health care, including many elective and non-cancer operations in the United States. Most hepato-pancreato-biliary malignancy patients require outpatient imaging, tissue sampling, and staging, and many undergo neoadjuvant therapy before operative intervention. The aims of this study were to evaluate the effect of the COVID-19 pandemic on hepato-pancreato-biliary oncologic operations and to determine whether trends in neoadjuvant therapy were altered by the pandemic. METHODS Adult patients in the United States undergoing oncologic operations for pancreatic, primary and secondary hepatic malignancies, with or without neoadjuvant therapy, were extracted from the Vizient Clinical Data Base. Control chart analysis was used to plot trends over time and to determine whether changes were statistically significant. Wilcoxon rank-sum tests also compared monthly operative volume from pre-pandemic (12 month) and pandemic (28 months) periods. RESULTS A total of 36,553 patients were identified over 40 months. Mean monthly pancreatic oncologic operations were unaffected by the pandemic (P = .257). Operations for pancreatic oncologic operations with prior neoadjuvant therapy increased throughout the pandemic (P = .002). Oncologic operations for primary and secondary hepatic malignancies were significantly reduced for 4 and 2 months, respectively, at the beginning of the pandemic but returned to their pre-pandemic baseline within 4 months (P = .169 and P = .598). CONCLUSION Pancreatic operation volumes for cancer did not change, but pancreatic operations after neoadjuvant therapy continued to increase during the pandemic. Operations for hepatic malignancy were transiently disrupted but quickly normalized. These observations suggest that surgery for hepato-pancreato-biliary malignancies was prioritized during the pandemic.
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Affiliation(s)
- Alexander Manzella
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Brett L Ecker
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Mariam F Eskander
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Miral S Grandhi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Haejin In
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Timothy Kravchenko
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Russell C Langan
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Timothy Kennedy
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - H Richard Alexander
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Toni Beninato
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Henry A Pitt
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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Fialka NM, El-Andari R, Jogiat U, Bédard ELR, Laing B, Nagendran J. Impact of the COVID-19 pandemic on esophageal cancer resource allocation: a systematic review. J Thorac Dis 2024; 16:1576-1589. [PMID: 38505032 PMCID: PMC10944786 DOI: 10.21037/jtd-23-1232] [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: 08/06/2023] [Accepted: 11/17/2023] [Indexed: 03/21/2024]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic challenged global infrastructure. Healthcare systems were forced to reallocate resources toward the frontlines. In this systematic review, we analyze the impact of resource reallocation during the COVID-19 pandemic on the diagnosis, management, and outcomes of esophageal cancer (EC) patients. Methods PubMed and Embase were systematically searched for articles investigating the impact of the COVID-19 pandemic on EC patients. Of the 1,722 manuscripts initially screened, 23 met the inclusion criteria. Results Heterogeneity of data and outcomes reporting prohibited aggregate analysis. Reduced detection of EC and considerable variability in disease stage at presentation were noted during the COVID-19 pandemic. EC patients experienced delays in diagnostic and preoperative staging investigations but surgical resection was not associated with greater short-term morbidity or mortality. Modeling the impact of pandemic-related delays in EC care predicts significant reductions in survival with associated economic losses in the coming years. Conclusions Amidst resource scarcity during the COVID-19 pandemic, the multidisciplinary management of patients with EC was affected at multiple stages in the care pathway. Although the complete ramifications of reductions in EC diagnosis and delays in care remain unclear, EC surgery was able to safely continue as a result of collaboration between centers, strict adherence to COVID-19 protective measures, and reallocation of healthcare resources towards the same. Ultimately, when healthcare systems are pushed to the brink, the downstream consequences of resource reallocation require judicious analysis to optimize overall patient outcomes.
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Affiliation(s)
- Nicholas M. Fialka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ryaan El-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Uzair Jogiat
- Division of Thoracic Surgery, Department of Surgery, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Eric L. R. Bédard
- Division of Thoracic Surgery, Department of Surgery, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Bryce Laing
- Division of Thoracic Surgery, Department of Surgery, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Geropoulos G, Moschonas S, Fanariotis G, Koltsida A, Madouros N, Koumadoraki E, Katsikas Triantafyllidis K, Kechagias KS, Koimtzis G, Giannis D, Notopoulos A, Pavlidis ET, Psarras K. Anastomotic Leak and Perioperative Outcomes of Esophagectomy for Esophageal Cancer during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:31. [PMID: 38256292 PMCID: PMC10818348 DOI: 10.3390/medicina60010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/27/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The coronavirus disease-2019 (COVID-19) pandemic influenced the healthcare system tremendously, as well as the number of elective surgical procedures worldwide. The aim of this study is to investigate the COVID-19 pandemic's impact on esophagectomies. Materials and Methods: The MEDLINE (via PubMed), Cochrane Library, and Google Scholar bibliographical databases were systematically searched. Original clinical studies investigating the outcomes of esophageal cancer surgery during the COVID-19 pandemic were deemed eligible. After exclusion criteria were applied, eight studies were considered eligible for inclusion. Results: Eight studies with non-overlapping populations, reporting on patients undergoing esophagectomy for resectable esophageal cancer during the COVID-19 pandemic, were included in our analysis, with a total of 18548 patients. Background characteristics for age, lung disease, smoking history as well as Body Mass Index and age were equal among the groups. The background of diabetes presented a statistically significant difference among the groups. Perioperative outcomes like reoperation rates, the length of intensive care unit stay, or readmission rates were not significantly increased during the pandemic. The 30-day readmission, and 30- and 90-day mortality were not affected either. The length of hospital stay was significantly lower in the non-pandemic period. Conclusions: The results of our study support the evidence that in the context of the COVID-19 pandemic, esophageal cancer operations took place safely and effectively, similarly to the standards of the non-COVID-19 era.
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Affiliation(s)
- Georgios Geropoulos
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Stavros Moschonas
- Surgery Working Group, Society of Junior Doctors, 15123 Athens, Greece; (S.M.); (A.K.); (E.K.)
| | - Georgios Fanariotis
- Surgery Working Group, Society of Junior Doctors, 15123 Athens, Greece; (S.M.); (A.K.); (E.K.)
| | - Aggeliki Koltsida
- Surgery Working Group, Society of Junior Doctors, 15123 Athens, Greece; (S.M.); (A.K.); (E.K.)
| | - Nikolaos Madouros
- Surgery Working Group, Society of Junior Doctors, 15123 Athens, Greece; (S.M.); (A.K.); (E.K.)
| | - Evgenia Koumadoraki
- Surgery Working Group, Society of Junior Doctors, 15123 Athens, Greece; (S.M.); (A.K.); (E.K.)
| | | | - Konstantinos S. Kechagias
- Department of Obstetrics and Gynaecology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge UB8 3NN, UK
| | - Georgios Koimtzis
- Department of General Surgery, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK;
| | - Dimitrios Giannis
- Department of Surgery, Flushing Hospital Medical Center, Flushing, NY 11355, USA;
| | - Athanasios Notopoulos
- Department of Nuclear Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Efstathios T. Pavlidis
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Kyriakos Psarras
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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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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Doeve BH, Bakx JAC, Siersema PD, Rosman C, van Grieken NCT, van Berge Henegouwen MI, van Sandick JW, Verheij M, Bijlsma MF, Verhoeven RHA, van Laarhoven HWM. The impact of the COVID-19 pandemic on the diagnosis, stage, and treatment of esophagogastric cancer. J Gastroenterol 2023; 58:965-977. [PMID: 37523094 PMCID: PMC10522512 DOI: 10.1007/s00535-023-02009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/07/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has affected the entire global healthcare system, including oncological care. This study investigated the effects of the COVID-19 pandemic on the diagnosis, stage, and treatment of esophagogastric cancer in the Netherlands. METHODS Patients diagnosed in 2020 were divided into 5 periods, based on the severity of the COVID-19 pandemic in the Netherlands, and compared to patients diagnosed in the same period in the years 2017-2019. Patient characteristics and treatments were evaluated for esophageal cancer (EC) and gastric cancer (GC) separately. RESULTS The number of esophagogastric cancer diagnoses decreased prominently during the first 2 months of the COVID-19 pandemic. During this period, a significantly higher percentage of GC patients was diagnosed with incurable disease (52.5% in 2017-2019 and 67.7% in 2020, p = 0.011). We observed a significant reduction in the percentage of patients with potentially curable EC treated with resection and neoadjuvant chemoradiotherapy (from 35.0% in 2017-2019 to 27.3% in 2020, p < 0.001). Also, patients diagnosed with incurable GC were treated less frequently with a resection (from 4.6% in 2017-2019 to 1.5% in 2020, p = 0.009) in the second half of 2020. CONCLUSIONS Compared to previous years, the number of esophagogastric cancer diagnoses decreased in the first 2 months of the COVID-19 pandemic, while an increased percentage of patients was diagnosed with incurable disease. Both in the curative and palliative setting, patients were less likely to be treated with a surgical resection.
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Affiliation(s)
- Benthe H Doeve
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
- Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Oncode Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Jeanne A C Bakx
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
| | - Nicole C T van Grieken
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Pathology, Amsterdam UMC, Location Vrije Universteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Johanna W van Sandick
- Department of Surgery, Antoni Van Leeuwenhoek Hospital - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
| | - Maarten F Bijlsma
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Oncode Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Rob H A Verhoeven
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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Griffiths EA, Kamarajah SK. Impact of the SARS-CoV-2 Pandemic on Treatment Pathways and Outcomes of Esophagogastric Cancer: A Pre- Versus Post-Pandemic Comparison of International Prospective Cohort Data. FOREGUT (THOUSAND OAKS, CALIF.) 2023:26345161231175981. [PMCID: PMC10352696 DOI: 10.1177/26345161231175981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Introduction: This study aimed to characterize the outcomes of esophagogastric (OG) cancer patients and compare perioperative outcomes with pre-pandemic data. Methods: Three international prospective cohort studies were included in this analysis. First, COVIDSurg-Cancer (n = 1999) included patients with an OG cancer planned for surgery from the start of the pandemic up to 14th April 2020 with follow-up until 31st August 2020. Treatment pathways and outcomes were compared against patients undergoing treatment for OG cancers before the pandemic, Oesophagogastric Anastomosis Audit (OGAA, n = 2246) and GlobalSurg 3 (n = 1256) study. The surgical composite outcome was defined as in patients achieving margin negative resection, resectability and no postoperative mortality. Results: This study included 1999 patients during the COVID-19 pandemic, of which 32.4% had a change from standard pre-pandemic management. Patients with delay to surgery had significantly higher rates of no surgery (24.7%vs 7.5%, P < .001) and less likely to have achieve a composite outcome (57.8%vs 73.4%, P < .001) than those without any delay in surgery. There was no significant difference in 30-day mortality (3.5% vs 3.4%; OR: 0.98, CI95%: 0.69-1.37) or anastomotic leak rate (10.9% vs 10.2%%; OR: 1.11, CI95%: 0.90-1.37) but higher reoperation rates (13.6% vs 10.4%; OR: 1.59, CI95%: 1.30-1.92) in patients between pre-pandemic and pandemic cohorts. Conclusion: The pandemic appears to have led to widespread changes in management pathways affecting one-third of patients. Developing elective surgical pathways resilient to periods of system “stress” are key to minimizing future harm from treatment delay for OG cancer patients.
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The COVID-19 Era Is Associated With Delays in Esophageal Cancer Diagnosis and Treatment. J Surg Res 2023; 285:100-106. [PMID: 36652768 PMCID: PMC9800812 DOI: 10.1016/j.jss.2022.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 11/19/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The coronavirus disease-2019 (COVID-19) pandemic has substantially affected the delivery of healthcare globally. The purpose of this study was to evaluate the association of this era with the timeline of care in esophageal cancer patients. METHODS We performed a retrospective chart-review of patients presenting to a single high-volume tertiary care center with the diagnosis of esophageal cancer. COVID era was defined as March 2020-December 2020 and compared with the year before (3/2019-12/2019). RESULTS In total, 117 patients presented in the COVID-era versus 190 in pre-COVID. Stage 3 + 4 disease was found in 77.8% of the patients in the COVID-era compared to 68.9% in the pre-COVID era (P = 0.34). Diagnoses through emergency department admission were 35.5% in the COVID versus 26.7% in the pre-COVID group (P = 0.15). In the COVID era it took a median of 78 d to visit primary care provider (versus 52 d, P = 0.12 in pre-COVID), 45 d to endoscopy (versus 18 d, P = 0.004) and 38 d to treatment initiation (versus 36 d, P = 0.48). Thirty-five percent of the patients underwent esophagectomy compared to 26% in the pre-COVID-era. Median days of intensive-care-unit (ICU) (2 versus 3, P = 0.16) and hospital stay (14 versus 15, P = 0.28) were similar in both groups as well as postoperative 30-day morbidities (63 versus 63%, P = 0.48). One-year follow-up showed 83.7% (95% confidence interval [CI]: 73.8%-90.1%) survival in the COVID-group compared to 76.4% (95% CI: 66.9%-83.5%) in the pre-COVID-group (P = 0.58). Only three patients had a positive COVID result. CONCLUSIONS Our institution treated fewer esophageal cancer patients during COVID-19 accompanied by a delay in endoscopic diagnosis. Postoperative outcomes and 1-year survival remained similar.
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Ingwersen E, Stam W, van Kesteren L, Wissink I, van Berge Henegouwen M, Besselink M, Busch O, Erdmann J, Eshuis W, Gisbertz S, Kazemier G, van der Peet D, Swijnenburg R, Zonderhuis B, Daams F. Impact of merging two university hospitals on surgical outcome after esophagogastric and hepato-pancreato-biliary surgery: Results from a retrospective study. Surg Open Sci 2023; 12:1-8. [PMID: 36747974 PMCID: PMC9898733 DOI: 10.1016/j.sopen.2023.01.002] [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: 10/26/2022] [Revised: 12/12/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
Background Due to centralization and super-specialization in medicine, hospital mergers are increasingly common. Their effect on postoperative outcomes in highly specialized surgical departments is unclear. As quality metrics often worsen after major organizational changes, preservation of quality of care during an hospital merge is of the utmost importance. Objective To evaluate the effect of a merger of two Dutch university hospitals on quality of surgical care, volume, and timeliness of care. Methods The upper gastro-intestinal and hepato-biliary-pancreatic sections merged on the 27th of January 2020 and the 31th of May 2021 respectively. Outcomes of all adult surgical patients were compared six months before and six months after the merger. Short-term quality metrics, volume, and timeliness of care were assessed. Results Overall, a cohort of 631 patients were included of whom 195 were upper gastro-intestinal (97 prior to the merger, 98 after the merger) and 436 (223 prior to the merger, 213 after) hepato-biliary-pancreatic patients. There were no differences in mortality, readmission, number and severity of complications, volume, and timeliness of care six months post-merger as compared to before merger. Conclusion This study shows that a hospital merger of two university hospitals can be performed without jeopardizing patient safety and while benefitting from centralization of highly specialized care and enhancement of medical research. Key message This study investigated the impact of a merger of two Dutch university hospitals on quality of care, timeliness of care, and volume. It showed no deterioration in the evaluated short-term quality metrics, volume or timeliness for upper GI and HPB surgery, suggesting that a hospital merger of two university hospitals can be performed safely, while benefitting from centralization of highly specialized care and enhancement of medical research.
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Affiliation(s)
- E.W. Ingwersen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - W.T. Stam
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - L.J. van Kesteren
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - I.J.A. Wissink
- Division of Infectious Diseases, Department of Medicine, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - M.I. van Berge Henegouwen
- Cancer Center Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - M.G. Besselink
- Cancer Center Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - O.R. Busch
- Cancer Center Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - J.I. Erdmann
- Cancer Center Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - W.J. Eshuis
- Cancer Center Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - S.S. Gisbertz
- Cancer Center Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - G. Kazemier
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - D.L. van der Peet
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - R.J. Swijnenburg
- Cancer Center Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - B. Zonderhuis
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - F. Daams
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
- Corresponding authorat: Amsterdam UMC location Vrije Universiteit Amsterdam, Surgery, De Boelelaan 1117, Amsterdam, the Netherlands.
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Wang Q, Yao C, Li Y, Luo L, Xie F, Xiong Q, Wu R, Wang J, Feng P. The safety of esophageal cancer surgery during COVID-19. Medicine (Baltimore) 2022; 101:e30929. [PMID: 36254035 PMCID: PMC9575394 DOI: 10.1097/md.0000000000030929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The ongoing coronavirus disease 2019 (COVID-19) pandemic has drastically challenged the safety of on esophageal cancer (EC) surgery during COVID-19. The study aimed to evaluate the safety of EC surgery during the COVID-19 pandemic. METHODS This systematic review was performed in accordance with the PRISMA-P 2015 guidelines and registered in PROSPERO (registration number: CRD42022335164). A systematic search of PubMed, Embase, Cochrane Library, Web of Science, Medline, Chinese National Knowledge Infrastructure database, Chinese Scientific Journal database, and Wan Fang database was conducted to identify potentially relevant publications from January 2020 to May 2022. All data were independently extracted by two researchers. We will apply a fixed-effect model or random effect model basis on the heterogeneity test and employ with RevMan 5.4.1 software for data synthesis. The dichotomous surgical outcomes used risk ratios or risk differences, and for continuous surgical outcomes, mean differences (MD) or standardized MD, both with 95% confidence intervals were used. The primary outcomes were postoperative complications, anastomotic leaks, and mortality. The secondary outcomes were total hospital stay, postoperative stay, preoperative waiting, operation time, blood loss, transfusion, postoperative intensive care unit (ICU) stay, number of patients needing ICU stay, and 30-day readmission. RESULTS This study will comprehensively summarize the high-quality trials to determine the safety of EC surgery during COVID-19. CONCLUSION Our systematic review and meta-analysis will present evidence for the safety of EC surgery during COVID-19.
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Affiliation(s)
- Qiuxiang Wang
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan Province, China
- Department of Traditional Chinese Medicine, The Central Hospital of Guangyuan City, Sichuan Province, China
| | - Chengjiao Yao
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan Province, China
- Department of Geriatrics of the Affiliated Hospital, Nanchong, Sichuan Province, China
| | - Yilin Li
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan Province, China
| | - Lihong Luo
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan Province, China
| | - Fengjiao Xie
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan Province, China
| | - Qin Xiong
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan Province, China
| | - Ruike Wu
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan Province, China
| | - Juan Wang
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan Province, China
| | - Peimin Feng
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan Province, China
- *Correspondence: Peimin Feng, Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan Province, China (e-mail: )
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Singhal R, Dickerson L, Sakran N, Pouwels S, Chiappetta S, Weiner S, Purkayastha S, Madhok B, Mahawar K. Safe Surgery During the COVID-19 Pandemic. Curr Obes Rep 2022; 11:203-214. [PMID: 34709586 PMCID: PMC8552630 DOI: 10.1007/s13679-021-00458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE OF REVIEW Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future. RECENT FINDINGS Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.
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Affiliation(s)
- Rishi Singhal
- Upper GI Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK.
| | - Luke Dickerson
- Department of General Surgery, Leighton Hospital, Crewe, UK
| | - Nasser Sakran
- Director Bariatric Centre, Department of Surgery, Emek Medical Centre, Afula, Israel
- The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Sonja Chiappetta
- Head Obesity and Metabolic Surgery, Ospedale Evangelico Betania, Naples, Italy
| | - Sylvia Weiner
- Department of Obesity and Metabolic Surgery, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | | | | | - Kamal Mahawar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
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11
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Bertozzi S, Taricani R, Tulissi I, Patusso F, Amura S, Londero AP. Redesigning doctor-patient relationship in the private health care during COVID-19 pandemic: Retrospective cohort study. Medicine (Baltimore) 2022; 101:e28781. [PMID: 35147107 PMCID: PMC8830855 DOI: 10.1097/md.0000000000028781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is experiencing pandemic diffusion. The experience of an Italian private health care structure was reviewed.We retrospectively collected data about services provided in a single medium complexity private health care structure. Furthermore, we classified specialties within 4 categories, based on the performance of urgent non-deferrable services and possible provision of services without a necessary contact with the patient.The structure canceled/postponed almost every deferrable service, providing only 3% of services that could be performed without direct contact with patients. Regarding non-deferrable services requiring the presence of the patient, about 42% of booked services have been autonomously canceled/postponed by patients for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) fear. The administrative services have been remotely performed by smart working as far as possible.Private health care structures may safely continue to provide non-deferrable services while respecting the restrictive measures imposed by the government, encouraging telehealth and smart working modalities.
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Affiliation(s)
- Serena Bertozzi
- Ennergi Research (non-profit organisation), Lestizza (UD), Italy
- Breast Unit, ASUFC, University Hospital of Udine, Udine, Italy
- Idea Medica Basaldella, Campoformido (UD), Italy
| | | | | | | | - Stefano Amura
- Ennergi Research (non-profit organisation), Lestizza (UD), Italy
| | - Ambrogio P. Londero
- Ennergi Research (non-profit organisation), Lestizza (UD), Italy
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, Genova, Italy
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12
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Hassan M, Le UT, Grapatsas K, Passlick B, Schmid S. [Surgery for Thoracic Malignancies during the COVID-19 Pandemic: a Case-control Study Investigating the Risk for Postoperative Complications]. Zentralbl Chir 2021; 146:579-585. [PMID: 34872113 DOI: 10.1055/a-1678-7533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The COVID-19 pandemic led to a major disturbance in the health care system. Many elective operations were postponed, including surgical oncology cases. Besides the need to contain hospital resources, this was also due to concerns about the safety to perform surgery during the pandemic and the impact of perioperative infections on postoperative outcomes. In this study we investigate the safety of surgery for thoracic malignancies during the COVID-19 pandemic. METHODS We retrospectively analysed the outcome of surgery for thoracic malignancies during the first, second and third waves of the COVID-19 pandemic (from 01.01. to 30.04.2020 and from 01.01. to 30.04.2021). As a control group we included the patients who received thoracic oncology surgeries during the same period in the last 2 years before the onset of the pandemic. The primary outcome was the rate of postoperative complications. RESULTS 236 operations were included in the pandemic group and 227 operations in the control group. There was no statistically significant difference in the rate of postoperative minor complications (16.1% vs. 18.5%, p = 0.5395) or major complications (12.2% vs. 10.13 %, p = 0.5563). The risk to develop postoperative pulmonary complications was not higher in the pandemic group (odds ratio 1.193, 95% CI 0.6515-2.203, p = 0.8232). There were 5 cases with COVID-19 infection after the operation in the pandemic group. There was no difference in the rate of postoperative mortalities (2 (0.85%) vs. 1 (0.44%), p > 0.9999) There was no COVID-19 related mortality. CONCLUSION Maintaining oncologic thoracic surgery during the COVID-19 pandemic is safe, feasible and not associated with increased risks of postoperative complications or mortalities.
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Affiliation(s)
- Mohamed Hassan
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Uyen-Thao Le
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | | | - Bernward Passlick
- Abteilung Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Severin Schmid
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
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13
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[Impact of COVID-19 on oncological surgery of the upper gastrointestinal tract]. Chirurg 2021; 92:929-935. [PMID: 34448904 PMCID: PMC8391856 DOI: 10.1007/s00104-021-01489-4] [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] [Accepted: 07/21/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND The outbreak of the coronavirus disease 2019 (COVID-19) pandemic imposed limitations for elective surgery, impacting the associated hospital standards worldwide. As certain treatment windows must be adhered to in oncological surgery, the limited intensive care unit (ICU) capacity had to be critically distributed in order to do justice to both acutely ill and oncology patients. This manuscript summarizes the impact of COVID-19 on the management of oncological surgery of the upper gastrointestinal tract and particularly esophageal surgery in German medical centers. MATERIAL AND METHODS A survey of German centers for esophageal surgery was performed on the impact of COVID-19 on operative management for esophageal surgery during the first lockdown. After inspection, assessment, critical analysis and interpretation, the results were compared to the international literature. RESULTS AND DISCUSSION Initial recommendations of international societies warned for caution and restraint regarding interventions of the upper gastrointestinal tract that were not absolutely necessary. Oncological surgery should be performed under strict restrictions, especially only after negative testing for COVID-19 and only with sufficiently available personal protective equipment for the personnel. Furthermore, minimally invasive procedures were preferably not recommended. In diseases with alternative treatment options, such as definitive chemoradiotherapy of esophageal squamous cell carcinoma, these should be given priority when possible. In the further development of the pandemic, it was shown that due to a high standardization of preoperative management, postoperative results comparable to pre-pandemic times could be achieved particularly with respect to the diagnostics of infections.
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Weksler B. Commentary: SARS-CoV-2 and Esophagectomy for Esophageal Cancer: Timely Operations and Good Outcomes. Semin Thorac Cardiovasc Surg 2021; 34:1081-1082. [PMID: 34271096 PMCID: PMC8276563 DOI: 10.1053/j.semtcvs.2021.07.003] [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: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Benny Weksler
- Division of Thoracic and Esophageal Surgery, Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, Pittsburgh Pennsylvania.
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15
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Mehtsun W, Tanabe K. Don't Let a Crisis Go to Waste. Ann Surg Oncol 2021; 28:4759-4761. [PMID: 34132949 PMCID: PMC8207811 DOI: 10.1245/s10434-021-10166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Winta Mehtsun
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth Tanabe
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA.
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Borgstein ABJ, van Berge Henegouwen MI. ASO Author Reflections: Safety of Performing Esophageal Cancer Surgery During the First Wave of the COVID-19 Pandemic in Europe: A Multicenter Study. Ann Surg Oncol 2021; 28:4814-4815. [PMID: 33763784 PMCID: PMC7990378 DOI: 10.1245/s10434-021-09891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Alexander B J Borgstein
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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