Delivering esophago-gastric cancer care during the COVID-19 pandemic in the United Kingdom: a surgical perspective

Abstract

Summary Background The COVID-19 pandemic continues to have a significant impact on the provision of medical care. Planning to ensure there is capability to treat those that become ill with the virus has led to an almost complete moratorium on elective work. This study evaluates the impact of COVID-19 on cancer, in particular surgical intervention, in patients with esophago-gastric cancer at a high-volume tertiary center. Methods All patients undergoing potential management for esophago-gastric cancer from 12 March to 22 May 2020 had their outcomes reviewed. Multi-disciplinary team (MDT) decisions, volume of cases, and outcomes following resection were evaluated. Results Overall 191 patients were discussed by the MDT, with a 12% fall from the same period in 2019, including a fall in new referrals from 120 to 83 (P = 0.0322). The majority of patients (80%) had no deviation from the pre-COVID-19 pathway. Sixteen patients had reduced staging investigations, 4 had potential changes to their treatment only, and 10 had a deviation from both investigation and potential treatment. Only one patient had palliation rather than potentially curative treatment. Overall 19 patients underwent surgical resection. Eight patients (41%) developed complications with two (11%) graded Clavien-Dindo 3 or greater. Two patients developed COVID-19 within a month of surgery, one spending 4 weeks in critical care due to respiratory complications; both recovered. Twelve patients underwent endoscopic resections with no complications. Conclusion Care must be taken not to compromise cancer treatment and outcomes during the COVID-19 pandemic. Excellent results can be achieved through meticulous logistical planning, good communication, and maintaining high-level clinical care.

Successful maintenance of process and outcomes for oesophageal cancer surgery in Ireland during the first wave of the COVID-19 pandemic

“…As we report herein, all patients had pre-operative PCR testing and selective CT thorax, and there was no postoperative COVID-19 infection during their inpatient stay. This reflects international experience [10,24,25] and suggests that continuing to provide urgent surgical oncology care is safe with a number of simple precautions. As services resume, it may be necessary to strengthen the public-private links to attenuate possible impaired access and surgical delays in the public system.…”

“…While these patients have progressed through the appropriate pathway, it is unclear how the patients with late or delayed diagnoses as a consequence of COVID-19 will fare. Others have also shown that some patients have changed their approach to treatments as a consequence of fear of contracting COVID-19 [25]. We have not accounted for that in this study, and it remains to be seen whether a similar attitude will emerge in our patient populace.…”

“…A further concern, not evident at this point, but a probable legacy of this pandemic, is of a real concern about delayed diagnosis of malignancies [25]. It is important that the hospital system demonstrates the flexibility to adapt and reconfigure as patient needs change.…”

COVID-19 Pneumonia on Post-Operative Day 2 after Esophagectomy: Performing Esophago-Gastric Junction Cancer Surgery during the SARS-Cov-2 Second Wave

“…Balancing between the risks of COVID-19-related perioperative complications and consequences of delaying surgical treatment is a challenge in EGJ cancer patients. However, available data indicate that EGJ cancer surgery can be successfully carried out without compromising patient outcomes [ 21 ].…”

The Effects of COVID-19 on Cancer Care Provision: A Systematic Review

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