Did the COVID-19 lockdown result in a delay of colorectal cancer presentation and outcomes? A single centre review

Abstract

Purpose The COVID-19 pandemic and resultant lockdown measures potentially delay management of non-communicable, life-limiting diseases like colorectal cancer (CRC) through avoidance of healthcare facilities by the public and diversion of resources within healthcare systems. This study aims to evaluate the impact of Singapore’s “Circuit Breaker (CB)” lockdown measures on CRC disease presentation and short-term surgical outcomes, while comparing Singapore’s approach against other countries which employed similar lockdown measures. Methods Patients whose initial diagnosis of CRC was made within the 6-month pre-CB (6/10/19–6/4/20) (“pre-CB group”) and post-CB (7/4/20–7/10/20) (“post-CB group”) period were enrolled retrospectively. The groups were compared based on severity of disease on presentation and short-term operative outcomes. Results In total, 105 patients diagnosed with CRC were enrolled in this study. When comparing pre-CB and post-CB groups, there was no significant difference in stage of CRC on presentation ( p = 0.850). There was also no increase in need for emergent operations ( p = 0.367). For patients who had undergone an operation, postoperative morbidity was not significantly higher in the post-CB group ( p = 0.201). Both groups of patients had similar length of stay in the hospital ( p = 0.438). Conclusion Unlike similar high-income countries, Singapore did not see later stage disease on presentation and poorer operative outcomes after lockdown measures. Possible reasons include lesser healthcare avoidance behaviours amongst Singaporeans, and adequate preparation of resources and contingency plans formed by hospitals after previous pandemics.

Influence of COVID-19 Pandemic on Colorectal Cancer Presentation, Management and Outcome during the COVID-19 Pandemic

“…The present study shows no differences in the number of laparoscopic colorectal resection during the pandemic. However, there was indeed an increase in ostomies as reported by other centers worldwide [ 51 , 52 , 53 ]. The higher stoma rate is mostly associated to the patient-related risk factors for anastomotic leakage according to Spinelli et al [ 54 ].…”

Colorectal Surgery Outcomes in the United States During the COVID-19 Pandemic

“…Our findings demonstrate a decrease in the total number of colorectal procedures performed during the pandemic, with the greatest decrease occurring from April-June 2020, coinciding with the start of the pandemic. Similar trends showing the greatest decrease in surgical volume in the early months of the pandemic with gradual resumption of surgical operations over the following months have been observed for colorectal procedures performed in England, 13 Ireland, 6 and Singapore, 14 as well as for non-colorectal procedures such as spine surgeries in the U.S. 15 This decrease in surgical volume may be attributed to early recommendations from professional societies to limit non-urgent surgeries; diagnostic testing like colonoscopy was also limited, resulting in fewer surgical referrals. 3 , 4 , 5 , 13 Additionally, patients may have avoided seeking healthcare or were managed medically rather than surgically, for fear of contracting COVID-19 or contributing to an overwhelmed healthcare system.…”

Trends in Colorectal Surgery During the COVID-19 Pandemic

“…In England for example, a population-based study showed a 92% reduction in the number of colonoscopies performed during the first wave of the pandemic. Interestingly, a report from Singapore showed no delay in presentation of colorectal cancer and no change in oncological or operative outcomes after lockdown measures. This laudable result was made possible because of the adequate preparation of resources and contingency plans formed by Singapore’s local health care system as lessons learned from previous airborne pandemics .…”

“…Interestingly, a report from Singapore showed no delay in presentation of colorectal cancer and no change in oncological or operative outcomes after lockdown measures. This laudable result was made possible because of the adequate preparation of resources and contingency plans formed by Singapore’s local health care system as lessons learned from previous airborne pandemics . Moreover, the geographical and population size of Singapore may have been uniquely helpful factors.…”

“…This laudable result was made possible because of the adequate preparation of resources and contingency plans formed by Singapore's local health care system as lessons learned from previous airborne pandemics. 5 Moreover, the geographical and population size of Singapore may have been uniquely helpful factors.…”