Impact of COVID-19 on pancreatic cancer surgery: A high-volume Polish center experience

Abstract

Background. A total of 148 surgeries were performed in our center on patients with pancreatic cancer in 2020. In 2019, 263 such procedures were performed (77.7% more) in this facility. Objectives.To analyze the impact of coronavirus disease 2019 (COVID-19) on pancreatic cancer surgery type, number and outcome in our center. Materials and methods.Retrospective data analysis of medical documentation in a hospital database from January 2019 till December 2020.Results. In 2020, we observed an increase of tumors localized in the tail of the pancreas (P) -29 cases (19.9%) in 2020 compared to 26 cases (9.9%) in 2019 (p = 0.005). In 2020, our patients presented with much greater advancement of the disease illustrated by the increased tumor size (median 3.5 cm in 2020 compared to 3.0 cm in 2019), although it did not reach statistical significance (p = 0.073). In 2020, we performed more palliative procedures, e.g., bypassing anastomoses (17 (11.6%) in 2020 compared to 8 (3%) in 2019 (p < 0.001)), more open biopsies of P (21 (14.4%) in 2020 compared to 21 (7.9%) in 2019 (p = 0.041)), and more percutaneous biopsies of P (7 (4.8%) in 2020 and 0 in 2019 (p = 0.001)). We observed a significant decrease in the number of Whipple procedures (53 (36.3%) in 2020 and 125 (47.5%) in 2019 (p = 0.037)). The most common histopathological finding was adenocarcinoma of the P, accounting for 50% in 2020 and almost 52% of all tumor cases in 2019. In a group of 148 patients operated on due to a P tumor during the COVID-19 pandemic, only 6 patients died, which resulted in a mortality rate of 4. 1% compared to 13.4% mortality rate in 2019 (34 deaths/263 patients; p = 0.005). We observed less leakage of gastrointestinal anastomosis (0/148 in 2020 and 10/263 in 2019 (p = 0.038)).Conclusions. Particular attention should be paid to patients with an aggressive type of cancer who have completed neoadjuvant therapy, as they are unable to undergo other therapeutic options. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive cancer patients should be postponed until recovery. Relatively few postoperative complications and low all-cause mortality are the result of a more careful selection of oncological patients before the admission to the surgical ward, as well as a ompliance with the principles of planning the procedure and organization of the operating theater during the COVID-19 pandemic.

Outcomes of Patients Undergoing Elective Pancreatic Surgery During COVID-19 Pandemic: A Multicenter, Prospective Cohort Study

“…Previous surgical studies have indicated that pancreatic surgery should be considered carefully for some special groups of patients with COVID-19, particularly those with positive symptoms, ensuring appropriate hospitalization duration. 25 Kędzierska-Kapuza et al 25 revealed an average postoperative hospitalization of 15.8 days, whereas our study showed longer average hospital stays of 24.7 days and 21.8 days for surgeries performed within 0-2 weeks and 2-4 weeks after infection, respectively. Therefore, our findings suggest a potential correlation between the time interval from infection to surgery and the length of hospital stay in patients infected with SARS-CoV-2.…”

Global Burden of Pancreatic Cancer Attributable to High Body-Mass Index in 204 Countries and Territories, 1990–2019

“…A comparative mortality study covering 28 countries of the European Union predicted that pancreatic cancer will surpass breast cancer by 2025 (there will be more deaths from pancreatic cancer than from breast cancer, while the number of pancreatic cancer deaths will increase by 25%), whereby pancreatic cancer will be the third leading cause of cancer death by 2025 (after lung cancer and colorectal cancer) [5]. It remains a question of what effect the COVID-19 pandemic will have on the burden of pancreatic cancer, since previous findings were not consistent: while the findings of a retrospective multicenter cohort study showed that there were no changes in clinical presentation, treatment strategies and survival of pancreatic cancer during the SARS-CoV-2 outbreak [6], some studies reported an increase in tumors localized in the tail of the pancreas and that patients presented with much greater advancement of the disease in 2020 compared to 2019 [7], and that a delay of only 3 months for surgery in stage II or III pancreatic cancer was associated with an over 17% reduction in long-term survival [8].…”

Assessment of the impact of the COVID-19 pandemic on the level of health care services in Poland - a review

“…Odnotowano m.in. znaczny spadek średniej liczby pacjentów rozpoczynających radioterapię [40], wydłużenie czasu od pierwszej wizyty do rozpoczęcia leczenia [41] oraz mniej wstępnych rozpoznań i rozszerzonych badań diagnostycznych i konsyliów onkologicznych [42], a także znaczne zmniejszenie liczby wykonywanych zabiegów operacyjnych [43,47] u pacjentów z chorobą nowotworową, chociaż w niektórych badaniach wskazywano na dostosowanie się systemu do zaistniałej sytuacji i stosunkowo szybki powrót do realizacji świadczeń na poziomie liczebnym sprzed pandemii [44,46]. Autorzy pracy zaznaczają konieczność prowadzenia dalszych obserwacji, aby określić długoterminowy wpływ pandemii na trendy i leczenie onkologiczne, ponieważ niekorzystne skutki mogą być opóźnione [45,46].…”