Impact of delay to surgery on survival in stage I-III colon cancer

Grass, Fabian; Behm, Kevin T.; Duchalais, Emilie; Crippa, Jacopo; Spears, Grant M.; Harmsen, William S.; Hübner, Martin; Mathis, Kellie L.; Kelley, Scott R.; Pembérton, John H.; Dozois, Eric J.; Larson, David W.

doi:10.1016/j.ejso.2019.11.513

Cited by 87 publications

(95 citation statements)

References 26 publications

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“…According to their estimates, 28’404’603 operations would be cancelled or postponed, concerning 81.7% of benign surgery and 37.7% of cancer surgery [ 14 ]. Delaying cancer may lead to deteriorating health, worsening quality of life, and unnecessary deaths [ 14 , 15 ]. On the contrary, in the present study, urgent interventions have always been provided, 24 hours a day, all specialties combined, as usual before the pandemic.…”

Section: Discussionmentioning

confidence: 99%

Surgery for non-Covid-19 patients during the pandemic

et al. 2020

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Background In the early phase of the Covid-19 pandemic, mainly data related to the burden of care required by infected patients were reported. The aim of this study was to illustrate the timeline of actions taken and to measure and analyze their impact on surgical patients. Method This is a retrospective review of actions to limit Covid-19 spread and their impact on surgical activity in a Swiss tertiary referral center. Data on patient care, human resources and hospital logistics were collected. Impact on surgical activity was measured by comparing 6-week periods before and after the first measures were taken. Results After the first Swiss Covid-19 case appeared on February 25, progressively restrictive measures were taken over a period of 23 days. Covid-19 positive inpatients increased from 5 to 131, and ICU patients from 2 to 31, between days 10 and 30, respectively, without ever overloading resources. A 43% decrease of elective visceral surgical procedures was observed after Covid-19 (295 vs 165, p<0.01), while the urgent operations (all specialties) decreased by 39% (1476 vs 897, p<0.01). Fifty-two and 38 major oncological surgeries were performed, respectively, representing a 27% decrease (p = 0.316). Outpatient consultations dropped by 59%, from 728 to 296 (p<0.01). Conclusion While allowing for maximal care of Covid-19 patients during the pandemic, the shift of resources limited the access to elective surgical care, with less impact on cancer care.

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Section: Discussionmentioning

confidence: 99%

Surgery for non-Covid-19 patients during the pandemic

et al. 2020

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“…Although not seen in smaller cohort studies, multiple large high-quality studies of the NCDB and SEER-Medicare databases demonstrate increasing time to surgery in colon cancer is associated with lower survival, with worse outcomes seen at as little as 30 to 40 days. 20 , 24, 41 These data support the expeditious resection of colon cancer whenever possible based upon available resources. Delayed resection of colon cancer leads to delayed staging, which in the setting of positive nodes would delay administration of chemotherapy.…”

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confidence: 74%

Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery

Fligor

Wang

Allar

et al. 2020

Journal of Gastrointestinal Surgery

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Background The COVID-19 pandemic has led to widespread cancelation of electively scheduled surgeries, including for colorectal, pancreatic, and gastric cancer. The American College of Surgeons and the Society of Surgical Oncology have released guidelines for triage of these procedures. We seek to synthesize available evidence on delayed resection and oncologic outcomes, while also providing a critical assessment of the released guidelines. Methods A systematic review was conducted to identify literature between 2005 and 2020 investigating the impact of time to surgery on oncologic outcomes in colorectal, pancreatic, and gastric cancer. Results For colorectal cancer, 1066 abstracts were screened and 43 papers were included. In primarily resected colon cancer, delay over 30 to 40 days is associated with lower survival. In rectal cancer, time to surgery over 7 to 8 weeks following neoadjuvant therapy is associated with decreased survival. Three hundred ninety-four abstracts were screened for pancreatic cancer and nine studies were included. Two studies demonstrate increased unexpected progression with delayed surgery over 30 days. Out of 633 abstracts screened for gastric cancer, six studies were included. No identified study demonstrated worse survival with increased time to surgery. Conclusion Moderate evidence suggests that delayed resection of colorectal cancer worsens survival; the impact of time to surgery on gastric and pancreatic cancer outcomes is uncertain. Early resection of gastrointestinal malignancies provides the best chance for curative therapy. During the COVID-19 pandemic, prioritization of procedures should account for available evidence on time to surgery and oncologic outcomes.

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“…Published reports provide evidence that survival rates are diminished for patients whose definitive operations are delayed beyond this window. [40][41][42] Patient safety during this pandemic is clearly of paramount importance; but safety is a two-edged sword. Safety derived from pursuit of institutional goals of social distancing, conservation of hospital resources, and preservation of PPEs are undoubtedly important.…”

Section: Advocacy For Cancer Patients In Time Of Covid-19 Pandemicmentioning

confidence: 99%

Surgical Oncologists and the COVID-19 Pandemic: Guiding Cancer Patients Effectively through Turbulence and Change

Hwang

Balch

et al. 2020

Ann Surg Oncol

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Background. The COVID-19 pandemic has posed extraordinary demands from patients, providers, and health care systems. Despite this, surgical oncologists must maintain focus on providing high-quality, empathetic care for the almost 2 million patients nationally who will be diagnosed with operable cancer this year. The focus of hospitals is transitioning from initial COVID-19 preparedness activities to a more sustained approach to cancer care. Methods. Editorial Board members provided observations of the implications of the pandemic on providing care to surgical oncology patients. Results. Strategies are presented that have allowed institutions to successfully prepare for cancer care during COVID-19, as well as other strategies that will help hospitals and surgical oncologists manage anticipated challenges in the near term. Perspectives are provided on: (1) maintaining a safe environment for surgical oncology care; (2) redirecting the multidisciplinary model to guide surgical decisions; (3) harnessing telemedicine to accommodate requisite physical distancing; (4) understanding interactions between SARS CoV-2 and cancer therapy; (5) considering the ethical impact of professional guidelines for surgery prioritization; and (6) advocating for our patients who require oncologic surgery in the midst of the COVID-19 pandemic. Conclusions. Until an effective vaccine becomes available for widespread use, it is imperative that surgical oncologists remain focused on providing optimal care for our cancer patients while managing the demands that the COVID-19 pandemic will continue to impose on all of us. The COVID-19 pandemic has required that health systems and medical care providers critically assess existing treatment algorithms across all healthcare settings. Cancer treatment is complex, with a range of urgencies for intervention, a large variety of potential treatment approaches, and numerous treatment sequencing options. Moreover, cancer patients are often elderly and have comorbidities, and cancer therapies frequently employ immunosuppressive agents. These factors converge to further intensify the complexities of cancer treatment during the COVID-19 pandemic. It is important to be mindful that, even with the

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Impact of delay to surgery on survival in stage I-III colon cancer

Cited by 87 publications

References 26 publications

Surgery for non-Covid-19 patients during the pandemic

Surgery for non-Covid-19 patients during the pandemic

Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery

Surgical Oncologists and the COVID-19 Pandemic: Guiding Cancer Patients Effectively through Turbulence and Change

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