Colorectal Services in Covid-19 Times: Minimally Invasive Surgery and Enhanced Recovery, the Need of the Hour

Abstract

The health services across the world have been deeply impacted by the ongoing COVID-19 pandemic which has resulted in diversion of resources to testing, isolating and treating COVID-19 patients. This meant cutting down resources and manpower away of various healthcare facilities and severely hampering the functioning of various cancer services across the world. It is however, important to understand, cancer itself is a life-threatening condition, and there is a need to continue running cancer care services, at least for those who needed the most. Various clinical societies have put forward guidelines and protocols to help continue surgical services during the pandemic. The role of minimally invasive surgery (MIS) was initially questioned at the start of the pandemic, however gradually increasing evidence favored MIS as it reduced hospital stay and complication. Enhanced recovery programs which have been introduced to various fields of surgery to improve outcomes and reduce hospital stay. It plays an essential role in times like this, where the optimal usage of minimal resources is essential. We embraced these methods to ensure safety of our patients and staff and at the same time provide the highest standards of care. Here we are presenting our experience of running a colorectal surgical unit during these difficult times with emphasis on promotion of minimally invasive surgery, at the epicenter of the pandemic in India.

Colorectal cancer in patients with SARS-CoV-2: a systematic review and meta-analysis

“…The detailed characteristics of the included studies are shown in Table 1 . There were 16 case report [ 16 , 32 , 46 , 48 – 50 , 52 , 54 , 55 , 59 , 66 , 67 , 71 , 75 , 82 , 84 ], 9 case series, 41 cohort [ 8 – 17 , 23 , 25 , 26 , 29 , 31 , 34 , 43 – 45 , 51 , 53 , 56 – 58 , 60 – 65 , 68 – 70 , 73 , 74 , 77 , 79 , 80 , 83 , 85 ], 2 cross-sectional [ 72 , 76 ] and 1 case–control [ 81 ] studies. These studies were conducted in China ( n = 15), Italy ( n = 8), United States ( n = 6), United Kingdom ( n = 6), Spain ( n = 5), India ( n = 4), France ( n = 3), Turkey ( n = 2), Brazil ( n = 2), Japan ( n = 2), Colombia ( n = 1), Philippines ( n = 1), Poland ( n = 1), Iran ( n = 1), The Netherlands ( n = 1), Belgium ( n = 1), United Arab Emirates ( n = 1), Mexico ( n = 1), Sweden ( n = 1), Austria ( n = 1), Hungary ( n = 1), Australia ( n = 1), and Chile ( n = 1).…”

“…Few studies were made within multi-countries ( n = 3) [ 9 , 12 , 51 ]. The majority of the studies were single centre [ 11 , 16 , 23 , 25 , 27 , 28 , 30 – 35 , 44 – 50 , 52 , 54 , 55 , 58 , 59 , 61 – 63 , 65 – 69 , 71 , 72 , 74 – 76 , 78 , 80 , 82 – 84 ] and only 25 studies were multi-centre [ 8 – 10 , 12 – 17 , 26 , 29 , 36 , 43 , 51 , 53 , 56 , 57 , 60 , 64 , 70 , 73 , 77 , 79 , 81 , 85 ]. The median NOS score for these studies was 6 (range, 5–7).…”

“…3 . In the hospital-acquired SARS-CoV-2 infected patients, subgroup analysis showed a significant difference in the rates between all patients (Europe, multi-countries, Asia and America) [ 9 , 10 , 25 – 28 , 30 , 31 , 35 , 36 , 47 , 51 , 53 , 56 , 57 , 60 , 61 , 65 , 68 , 69 , 72 , 74 , 77 , 79 , 80 , 83 , 85 ]; and Europe only patients [1.1% (95% CI 0.5 to 1.6, n = 178, 12 studies, I 2 = 91%)] [ 10 , 25 – 27 , 35 , 47 , 53 , 56 , 60 , 61 , 77 , 79 ]; multi-countries only patients [4.7% (95% CI 3.6 to 5.9, n = 212, 2 studies, I 2 = 90%)] [ 9 , 51 ]; Asia only patients [0.7% (95% CI 0.0 to 1.4, n = 32, 9 studies, I 2 = 69%)] [ 28 , 31 , 36 , 57 , 65 , 68 , 74 , 83 , 85 ]; and America only patients [2.3% (95% CI 0.9 to 3.6, n = 32, 4 studies, I 2 = 10%)] [ 30 , 69 , 72 , 80 ], respectively; Fig. 4 .…”

“…The median patient age ranged from 51.6 years to 80 years across studies. There was an increased male predominance in CRC patients diagnosed with SARS-CoV-2 in most of the studies [ n = 2243, 66.7%] [ 9 , 11 , 14 , 16 , 17 , 25 , 27 , 28 , 30 , 32 – 35 , 47 , 52 – 59 , 61 , 62 , 71 , 72 , 74 , 75 , 77 , 81 – 85 ] and majority of the patients belonged to White (Caucasian) ( n = 262, 7.8%), Hispanic ( n = 156, 4.6%) and Asian ( n = 153, 4.5%) ethnicity [ 11 , 13 – 17 , 25 – 34 , 36 , 43 , 44 , 46 – 50 , 52 – 55 , 57 – 61 , 67 , 70 – 73 , 75 – 78 , 80 , 81 , 83 – 85 ]. Most patients were diagnosed for CRC through symptoms, endoscopy, radiological imaging, biopsies and tumor markers [ 8 – 10 , 12 – 14 , 16 , 17 , 23 , 25 – 36 , 43 , 44 , 46 – 56 , 58 – 61 , 65 – 77 ...…”

“…The main source of SARS-CoV-2 infection in CRC patients was community-acquired ( n = 2882, 85.7%; p = 0.014) [ 8 , 11 – 17 , 23 , 28 , 29 , 33 , 34 , 43 – 45 , 48 , 50 , 52 , 55 , 58 , 59 , 62 – 67 , 70 , 71 , 75 , 76 , 81 – 83 ]. Most of those SARS-CoV-2 patients had stage III CRC ( n = 725, 21.6%; p = 0.036) [ 9 , 13 , 17 , 35 , 45 , 72 , 83 ]; and were treated mainly with surgical resections ( n = 304, 9%) and chemotherapies ( n = 187, 5.6%), p = 0.008 [ 9 – 11 , 16 , 17 , 23 , 25 , 26 , 28 , 29 , 31 – 36 , 43 – 45 , 47 , 49 , 51 , 53 , 54 , 56 – 58 , 60 , 61 , 68 , 72 , 74 , 77 , 80 , 82 , 85 ]. The most common tumor symptoms patients experienced were change in bowel habits ( n = 26, 0.8%), diarrhoea ( n = 25, 0.7%), abdominal pain ( n = 23, 0.7%), and nausea and vomiting ( n = 21, 0.6%); p =...…”