Effects of COVID-19 pandemic on colorectal cancer surgery

IMPACT OF THE COVID-19 PANDEMIC ON THE EMERGENCY SURGICAL TREATMENT OF COLORECTAL CANCER

BACKGROUND

Colorectal cancer (CRC) is the most common malignancy of the gastrointestinal tract and the third most common type of cancer worldwide. The COVID-19 pandemic, during the years 2020 and 2022, increased the difficulties in offering adequate early diagnosis and treatment to CRC patients worldwide. During this period, it was only possible to treat patients who evolved with complications, mainly intestinal obstruction and perforation.

AIMS

To assess the impact of the COVID-19 pandemic on the treatment of patients with CRC.

METHODS

A review of data from a total of 112 patients undergoing emergency surgical treatment due to complications of CRC was carried out. Of these, 78 patients underwent emergency surgery during the COVID-19 pandemic (2020/2021), and 34 were treated before the pandemic (2018/2019). Ethnic aspects, clinical symptoms, laboratory tests, histopathological variables, intra and postoperative complications, and 90-day postoperative follow-up were compared between the two groups.

RESULTS

Between the years 2018 and 2019, 79.4% (27/34) of patients had intestinal obstruction, while 20.6% (7/34) had intestinal perforation. During the period of the COVID-19 pandemic (2020/2021), 1.3% (1/78) of patients underwent surgery due to gastrointestinal bleeding, 6.4% (5/78) due to intestinal perforation, and 92.3% (72/78) due to intestinal obstruction. No statistically significant differences were recorded between the two groups in ethnic aspects, laboratory tests, type of complications, number of lymph nodes resected, compromised lymph nodes, TNM staging, pre or intraoperative complications, length of stay, readmission, or mortality rate. When considering postoperative tumor staging, among patients operated on in 2018/2019, 44.1% were classified as stage III and 38.2% as stage IV, while during the pandemic period, 28.2% presented stage III and 51.3% stage IV, also without a statistically significant difference between the two periods. Patients operated on during the pandemic had higher rates of vascular, lymphatic and perineural invasion.

CONCLUSIONS

The COVID-19 pandemic increased the rate of complications related to CRC when comparing patients treated before and during the pandemic. Furthermore, it had a negative impact on histopathological variables, causing worse oncological prognoses in patients undergoing emergency surgery.

The occupational burnout among medical staff with high workloads after the COVID-19 and its association with anxiety and depression

Objective

After the end of COVID-19, medical staff were immediately faced with a high workload, leading to widespread occupational burnout. This study aims to explore the level and influencing factors of burnout among medical staff during this period, as well as its relationship with anxiety and depression.

Methods

The participants' levels of burnout were assessed using Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and the reliability and validity of the questionnaire were evaluated through Cronbach's α and Confirmatory Factor Analysis (CFA). Independent sample t-test, chi-square test, and Pearson analysis were employed to determine the correlation between two sets of variables. Univariate and multivariate logistic regression analyses were conducted to identify significant factors influencing burnout. Finally, nomograms were used to predict the probability of burnout occurrence.

Results

This study collected a total of 1,550 questionnaires, and after excluding 45 questionnaires that were duplicates or incomplete, a sample of 1,505 (97.1%) participants were included in the final statistical analysis. Both Cronbach's α and the fit indices of CFA demonstrated excellent adaptability of the Chinese version of MBI-HSS in this study. The overall prevalence rates for emotional exhaustion (EE), depersonalization (DP), and diminished personal accomplishment (PA) were 52.4, 55.3, and 30.6%, respectively. Obtaining psychological support, health condition, relationship with family members, and insufficient sleep were identified as common contributing factors to burnout among medical staff. Additionally, age and promotion pressure were also associated with burnout among doctors, and exceeding legal working hours was an important factor for nurse burnout. The C-index for the nomograms predicting burnout among doctors and nurses was 0.832 and 0.843, respectively. Furthermore, burnout exhibited a significant linear correlation with anxiety and depression.

Conclusion

After the end of COVID-19, medical staff in high workload environments were facing severe burnout, which might lead to anxiety and depression. The occupational burnout of medical staff needed to be taken seriously and actively intervened.

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.

The safety of digestive tract cancer surgery during COVID-19: A living systematic review and meta-analysis

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.

The safety of colorectal cancer surgery during the COVID-19: a systematic review and meta-analysis

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.

Disappearing Colorectal Liver Metastases: Do We Really Need a Ghostbuster?

The development of new systemic treatment strategies has resulted in a significant increase in the response rates of colorectal liver metastases (CRLM) in the last few years. Although the radiological response is a favorable prognostic factor, complete shrinkage of CRLM, known as disappearing liver metastases (DLM), presents a therapeutic dilemma, and proper management is still debated in the literature. In fact, DLM is not necessarily equal to cure, and when resected, pathological examination reveals in more than 80% of patients a variable percentage of the tumor as residual disease or early recurrence in situ. Moreover, while a higher incidence of intrahepatic recurrence is documented in small series when surgery is avoided, its clinical significance for long-term OS is still under investigation. In light of this, a multidisciplinary approach and, in particular, radiologists’ role is needed to assist the surgeon in the management of DLM, thanks to emerging technology and strategy. Therefore, the aim of this review is to provide an overview of the DLM phenomenon and current management.

Clinical presentation, management, screening and surveillance for colorectal cancer during the COVID-19 pandemic

Management of colorectal cancer (CRC) was severely affected by the changes implemented during the pandemic, and this resulted in delayed elective presentation, increased emergency presentation, reduced screening and delayed definitive therapy. This review was conducted to analyze the impact of the coronavirus disease 2019 (COVID-19) pandemic on management of CRC and to identify the changes made in order to adapt to the pandemic. We performed a literature search in PubMed, Medline, Index Medicus, EMBASE, SCOPUS, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Google Scholar using the following keywords in various combinations: Colorectal cancer, elective surgery, emergency surgery, stage upgrading, screening, surveillance and the COVID-19 pandemic. Only studies published in English were included. To curtail the spread of COVID-19 infection, there were modifications made in the management of CRC. Screening was limited to high risk individuals, and the screening tests of choice during the pandemic were fecal occult blood test, fecal immunochemical test and stool DNA testing. The use of capsule colonoscopy and open access colonoscopy was also encouraged. Blood-based tests like serum methylated septin 9 were also encouraged for screening of CRC during the pandemic. The presentation of CRC was also affected by the pandemic with more patients presenting with emergencies like obstruction and perforation. Stage migration was also observed during the pandemic with more patients presenting with more advanced tumors. The operative therapy of CRC was altered by the pandemic as more emergencies surgeries were done, which may require exteriorization by stoma. This was to reduce the morbidity associated with anastomosis and encourage early discharge from the hospital. There was also an initial reduction in laparoscopic surgical procedures due to the fear of aerosols and COVID-19 infection. As we gradually come out of the pandemic, we should remember the lessons learned and continue to apply them even after the pandemic passes.

The effect of the COVID-19 pandemic on the outcomes of surgically treated colorectal diseases: a retrospective cohort study

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.