85-91DOI: 10.17235/reed.2020.7460/2020
Patricia Tejedor, Vicente Simó, Jorge Arredondo, Irene López-Rojo, Jorge Baixauli, Luis Miguel Jiménez, Marcos Gómez-Ruiz, Carlos Pastor, Project Working Group on behalf of Project Working Group*,
* Project Working Group: Project Working Group, Juan Jose Pérez Alegre, Enrique Pastor Teso, Maria Isabel Martínez Rodríguez, Javier Sánchez González, Ekta Choolani Bhojwani, Ignacio Paredes, Ricardo Iglesias, Oscar Alonso Casado, Luis de Nicolás Navas, Gloria Ortega-Pérez, Carlos Sánchez Justicia, Sara Rosenstone Calvo, Jaime Zorrilla Ortúzar, Elena Hurtado Caballero, Carmen Cagigas Fernández, Lidia Cristobal Poch, Lucía Granero Peiró, Patricia Martínez Ortega
Abstract
Objective: the aim of the study was to analyze the management of colorectal cancer (CRC) patients diagnosed with CRC or undergoing elective surgery during the period of the SARS-CoV-2 pandemic.
Material and methods: a multicenter ambispective analysis was performed in nine centers in Spain during a four-month period. Data were collected from every patient, including changes in treatments, referrals or delays in surgeries, changes in surgical approaches, postoperative outcomes and perioperative SARS-CoV-2 status. The hospital’s response to the outbreak and available resources were categorized, and outcomes were divided into periods based on the timeline of the pandemic.
Results: a total of 301 patients were included by the study centers and 259 (86 %) underwent surgery. Five hospitals went into phase III during the peak of incidence period, one remained in phase II and three in phase I. More than 60 % of patients suffered some form of change: 48 % referrals, 39 % delays, 4 % of rectal cancer patients had a prolonged interval to surgery and 5 % underwent neoadjuvant treatment. At the time of study closure, 3 % did not undergo surgery. More than 85 % of the patients were tested preoperatively for SARS-CoV-2. A total of nine patients (3 %) developed postoperative pneumonia; three of them had confirmed SARS-CoV-2. The observed surgical complications and mortality rates were similar as expected in a usual situation.
Conclusions: the present multicenter study shows different patterns of response to the SARS-CoV-2 pandemic and collateral effects in managing CRC patients. Knowing these patterns could be useful for planning future changes in surgical departments in preparation for new outbreaks.
New comment
Comments
No comments for this article
References
1. Wang, D., Hu, B., Hu, C., et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. Jama 2020.
2. Zhu, N., Zhang, D., Wang, W., et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020;382:727-733.
3. Holshue, M. L., DeBolt, C., Lindquist, S., et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med 2020;382:929-936.
4. Silverstein, W. K., Stroud, L., Cleghorn, G. E. and Leis, J. A. First imported case of 2019 novel coronavirus in Canada, presenting as mild pneumonia. Lancet 2020;395:734.
5. Acter, T., Uddin, N., Das, J., Akhter, A., Choudhury, T. R. and Kim, S. Evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as coronavirus disease 2019 (COVID-19) pandemic: A global health emergency. Sci Total Environ 2020;730:138996.
6. Søreide, K., Hallet, J., Matthews, J. B., et al. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg 2020.
7. SAGES and EAES Recommendations regarding surgical response to COVID-19 crisis - SAGES. from https://www.sages.org/recommendations-surgical-response-covid-19/
COVIDSurg Collaborative. Global guidance for surgical care during the COVID-19 pandemic [published online ahead of print, 2020 Apr 15]. Br J Surg. 2020;10.1002/bjs.11646. doi:10.1002/bjs.11646
9. Brindle, M. E. and Gawande, A. Managing COVID-19 in Surgical Systems. Ann Surg 2020.
10. Lei, S., Jiang, F., Su, W., et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine 2020;21:100331.
11. Dindo, D., Demartines, N. and Clavien, P. A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.
12. (AEC), S. S. A. (2020). Documentos de posicionamiento y recomendaciones de la AEC. from https://www.aecirujanos.es/Documentos-de-posicionamiento-y-recomendaciones-de-la-AEC-en-relacion-con-la-cirugia-y-COVID19_es_116_508_0_345.html
Tan KK, Moran BJ, Solomon MJ. Avoiding collateral mortality in a pandemic - time to change our mindset in surgical oncology. Nat Rev Clin Oncol. 2020;17(7):383-385. doi:10.1038/s41571-020-0383-1
14. Kutikov, A., Weinberg, D. S., Edelman, M. J., Horwitz, E. M., Uzzo, R. G. and Fisher, R. I. A War on Two Fronts: Cancer Care in the Time of COVID-19. Ann Intern Med 2020;172:756-758.
15. Ren, X., Chen, B., Hong, Y., et al. The challenges in colorectal cancer management during COVID-19 epidemic. Ann Transl Med 2020;8:498.
COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans [published online ahead of print, 2020 May 12]. Br J Surg. 2020;10.1002/bjs.11746. doi:10.1002/bjs.11746
Sud A, Jones ME, Broggio J, et al. Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic. Ann Oncol. 2020;31(8):1065-1074. doi:10.1016/j.annonc.2020.05.009
18. Grass, F., Behm, K. T., Duchalais, E., et al. Impact of delay to surgery on survival in stage I-III colon cancer. Eur J Surg Oncol 2020;46:455-461.
19. Burns, E. M., Boyle, K., Mirnezami, A. and Jenkins, J. T. The impact of COVID-19 on advanced colorectal cancer. Colorectal Dis 2020;22:737-738.
20. Surgeons, R. C. o. (2020). Updated intercollegiate general surgery guidance on COVID-19. from https://www.sages.org/recommendations-surgical-response-covid-19/.
21. Mintz, Y., Arezzo, A., Boni, L., Chand, M., Brodie, R. and Fingerhut, A. A Low Cost, Safe and Effective Method for Smoke Evacuation in Laparoscopic Surgery for Suspected Coronavirus Patients. Ann Surg 2020.
22. Boni, L., Fingerhut, A., Marzorati, A., Rausei, S., Dionigi, G. and Cassinotti, E. Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc 2017;31:1836-1840.
23. Kwak, H. D., Kim, S. H., Seo, Y. S. and Song, K. J. Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery. Occup Environ Med 2016;73:857-863.
24. Wexner, S. D., Cortés-Guiral, D., Gilshtein, H., Kent, I. and Reymond, M. A. COVID-19: impact on colorectal surgery. Colorectal Dis 2020.
25. Coccolini, F., Perrone, G., Chiarugi, M., et al. Surgery in COVID-19 patients: operational directives. World J Emerg Surg 2020;15:25.
COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study [published correction appears in Lancet. 2020 Jun 9;:]. Lancet. 2020;396(10243):27-38. doi:10.1016/S0140-6736(20)31182-X
27. Preoperative testing and screening for elective surgery during the pandemic COVID-19 to re-start surgery. from https://eaes.eu/covid-19-statements/preoperative-testing-and-screening-for-elective-surgery-during-the-pandemic-covid-19-to-re-start-surgery/
28. Jessop, Z. M., Dobbs, T. D., Ali, S. R., et al. Personal Protective Equipment (PPE) for Surgeons during COVID-19 Pandemic: A Systematic Review of Availability, Usage, and Rationing. Br J Surg 2020.
29. Brücher, B. L. D. M., Nigri, G., Tinelli, A., et al. COVID-19: Pandemic surgery guidance. 4open 2020;3:1.
30. Colorectal cancer services during the COVID-19 pandemic. Br J Surg 2020;107:e255-e256.
31. COVIDSurg - Cancer (NCT04384926). from https://globalsurg.org/cancercovidsurg/
Crespo, J., Iglesias-García, J., Hinojosa Del Val, J. E., et al. COVID-19 and the digestive system: protection and management during the SARS-CoV-2 pandemic. Rev Esp Enferm Dig 2020;112:389-396.