Impact of COVID-19 outbreak on esophageal cancer surgery in Northern Italy: lessons learned from a multicentric snapshot

Abstract

Coronavirus Disease-19 (COVID-19) outbreak has significantly burdened healthcare systems worldwide, leading to reorganization of healthcare services and reallocation of resources. The Italian Society for Study of Esophageal Diseases (SISME) conducted a national survey to evaluate changes in esophageal cancer management in a region severely struck by COVID-19 pandemic. A web-based questionnaire (26 items) was sent to 12 SISME units. Short-term outcomes of esophageal resections performed during the lockdown were compared with those achieved in the same period of 2019. Six (50%) centers had significant restrictions in their activity. However, overall number of resections did not decrease compared to 2019, while a higher rate of open esophageal resections was observed (40 vs. 21.7%; P = 0.034). Surgery was delayed in 24 (36.9%) patients in 6 (50%) centers, mostly due to shortage of anesthesiologists, and occupation of intensive care unit beds from intubated COVID-19 patients. Indications for neoadjuvant chemo (radio) therapy were extended in 14% of patients. Separate COVID-19 hospital pathways were active in 11 (91.7%) units. COVID-19 screening protocols included nasopharyngeal swab in 91.7%, chest computed tomography scan in 8.3% and selective use of lung ultrasound in 75% of units. Postoperative interstitial pneumonia occurred in 1 (1.5%) patient. Recovery from COVID-19 pandemic was characterized by screening of patients in all units, and follow-up outpatient visits in only 33% of units. This survey shows that clinical strategies differed considerably among the 12 SISME centers. Evidence-based guidelines are needed to support the surgical esophageal community and to standardize clinical practice in case of further pandemics.

Impact of the coronavirus disease 2019 pandemic on first-visit patients with oesophageal cancer in the first infection wave in Saitama prefecture near Tokyo: a single-centre retrospective study

“…A multicentre study in Italy revealed an increase in waiting time before surgery and preoperative therapy due to a shortage of anesthesiologists and occupation of intensive care unit beds by intubated patients with COVID-19. Although the overall number of resections did not decrease compared with that in 2019, a higher rate of open oesophageal resections was observed ( 17 ). However, our institution did not implement any medical treatment restrictions during pandemic.…”

Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a Scoping Review

“…From these indicators, 11 (73%) showed similar complication rates. One Italian survey [127] has also documented a stable number of complications after esophageal resections.…”

“…One Italian survey [127] has also documented a stable number of complications after esophageal resections.…”

The Impact of COVID-19 Pandemic on Oncological Disease Extent at Staging FDG PET/CT: the ONCOVIPET Study.

“…The rst phase of the emergency determined a reduction in inpatient and outpatient services provided to non-COVID patients i.e. the delay or suspension of important screening programs, the limitation of some diagnostic tests such as CT to the emergency context and the cancellation or delay of specialist visits and some elective procedures such as biopsies or surgeries [26][27][28][29][30]. Several European Countries reported that cancer diagnosis rates plummeted when the pandemic began, between 15% and 40%.…”