Surgical Treatment and Outcomes of Colorectal Cancer Patients During the COVID-19 Pandemic: A National Population-based Study in England

Abstract

Objective: To compare the management and outcomes of colorectal cancer (CRC) patients during the first 2 months of the COVID-19 pandemic with the preceding 6 months. Background: The pandemic has affected the diagnosis and treatment of CRC patients worldwide. Little is known about the safety of major resection and whether creating “cold” sites (COVID-free hospitals) is effective. Methods: A national study in England used administrative hospital data for 14,930 CRC patients undergoing surgery between October 1, 2019, and May 31, 2020. Mortality of CRC resection was compared before and after March 23, 2020 (“lockdown” start). Results: The number of elective CRC procedures dropped sharply during the pandemic (from average 386 to 214 per week), whereas emergency procedures were hardly affected (from 88 to 84 per week). There was little change in characteristics of surgical patients during the pandemic. Laparoscopic surgery decreased from 62.5% to 35.9% for elective and from 17.7% to 9.7% for emergency resections. Surgical mortality increased slightly (from 0.9% to 1.2%, P = 0.06) after elective and markedly (from 5.6% to 8.9%, P = 0.003) after emergency resections. The observed increase in mortality during the first phase of the pandemic was similar in “cold” and “hot” sites ( P > 0.5 elective and emergency procedures). Conclusions: The pandemic resulted in a 50% reduction in elective CRC procedures during the initial surge and a substantial increase in mortality after emergency resection. There was no evidence that surgery in COVID-free “cold” sites led to better outcomes in the first 2 months.

Colorectal Surgery in the COVID-19 Era: A Systematic Review and Meta-Analysis

“…After screening 283 abstracts generated by the search algorithm, 10 studies were deemed eligible for inclusion in the final quantitative analysis ( Figure 1 ). In total, 26,808 patients were incorporated in the analysis (19,152 in the pre-pandemic cohort and 7656 in the pandemic cohort), with five studies being from east Asia (one from Japan [ 14 ], two from China [ 15 , 16 ], and two from Korea [ 17 , 18 ]) and the remaining five from Europe (two from the United Kingdom [ 11 , 19 ], one from Italy [ 20 ], one from Ireland [ 3 ], and one from Serbia [ 21 ]). The size of the pandemic cohorts in each study was compared to that of the pre-pandemic cohorts after matching for the time duration of the data collection in the pandemic cohorts (in months).…”

“…The study by Kuryba et al [ 19 ] was the only study to report data on mortality, derived from a large UK-based population registry, revealing 2.6% mortality rates in the pandemic cohort versus 1.6% in the pre-pandemic one. The encountered marginal increase in mortality was mainly attributable to emergency surgery cases (OR 1.74, p = 0.003) and was especially pronounced in so-called “hot-sites”, i.e., centers that accommodated COVID-19 positive patients as well as elective and emergency colorectal cancer cases.…”

Surgical safety in the COVID-19 era: present and future considerations

“…Clinicians must treat cancer patients in accordance with their individual characteristics, the involved organ(s), the tumor stage, and the available adjuvant treatments. Although some studies have indicated an increase in T4 stage cancer during the pandemic, most have reported no significant upstaging in terms of the TNM classification ( Table 3 ) [ 8 28 33 57 58 59 60 61 62 63 ]. A hasty or obstinate selection of surgical resection is thus unnecessary in positive COVID-19 cases if other treatment modalities are available.…”

The risk of contracting SARS-CoV-2 or developing COVID-19 for people with cancer: A systematic review of the early evidence

“…In the early stages of the pandemic, concerns regarding the risk of SARS-CoV-2 exposure, susceptibility to infection, and severity of COVID-19 for people with cancer led to cancer treatment changes in different countries and settings [33] , [34] , [35] , [36] , [37] , [38] , [39] . The precautionary principle is important in early and urgent decision-making; however, treatment changes can also have negative effects, so it is crucial to generate high-quality timely evidence on the magnitude of risks to inform more nuanced decisions.…”