The effect of the first year of the COVID-19 pandemic on sphincter preserving surgery for rectal cancer: A single referral center experience

Freund, Michael R.; Kent, Ilan; Horesh, Nir; Smith, Timothy M.; Zamis, Marcella; Meyer, Ryan; Yellinek, Shlomo; Wexner, Steven D.

doi:10.1016/j.surg.2022.02.006

Cited by 9 publications

(13 citation statements)

References 29 publications

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“…Although the initial concern regarding the enhanced viral transmission related to aerosolisation associated with minimally invasive surgery was rapidly allayed by different societal guidelines, however, there have been reports of up to 20% decrease in minimally invasive surgeries for rectal cancer from some Chinese centres [ 45 ]. However, some European and American centres reported no difference in minimally invasive colorectal surgeries during Covid-19 pandemic with strict adherence to the societal guidelines [ 46 , 47 ]. Increase in minimally invasive colorectal surgeries during the Covid-19 era in our study may be explained by strict adherence to the precautionary measures adopted in these centres and benefits related to enhanced postoperative recovery and decreased respiratory complications.…”

Section: Discussionmentioning

confidence: 99%

Impact of Covid-19 on gastrointestinal cancer surgery: A National Survey

Parray

Chaudhari

Bhandare

et al. 2022

Langenbecks Arch Surg

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Purpose To understand the actual impact of the Covid-19 pandemic and frame the future strategies, we conducted a pan India survey to study the impact on the surgical management of gastrointestinal cancers. Methods A national multicentre survey in the form of a questionnaire from 16 tertiary care gastrointestinal oncology centres across India was conducted from January 2019 to June 2021 that was divided into a 15-month pre-Covid era and a similar period of active Covid pandemic era. Results There was significant disruption of services; 13 (81%) centres worked as dedicated Covid care centres and 43% reported suspension of essential care for more than 6 months. In active Covid phase, there was a 14.5% decrease in registrations and proportion of decrease was highest in the centres from South zone (22%). There was decrease in resections across all organ systems; maximum reduction was noted in hepatic resections (33%) followed by oesophageal and gastric resections (31 and 25% respectively). There was minimal decrease in colorectal resections (5%). A total of 584 (7.1%) patients had either active Covid-19 infection or developed infection in the post-operative period or had recovered from Covid-19 infection. Only 3 (18%) centres reported higher morbidity, while the rest of the centres reported similar or lower morbidity rates when compared to pre-Covid phase; however, 6 (37%) centres reported slightly higher mortality in the active Covid phase. Conclusion Covid-19 pandemic resulted in significant reduction in new cancer registrations and elective gastrointestinal cancer surgeries. Perioperative morbidity remained similar despite 7.1% perioperative Covid 19 exposure. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-022-02675-6.

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Section: Discussionmentioning

confidence: 99%

Impact of Covid-19 on gastrointestinal cancer surgery: A National Survey

Parray

Chaudhari

Bhandare

et al. 2022

Langenbecks Arch Surg

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“…We noticed an increase in TNT as in the first phases of the pandemic, as patients were more often referred to TNT to preserve healthcare resources. 18 …”

Section: Methodsmentioning

confidence: 99%

Total Neoadjuvant Therapy Is a Predictor for Complete Pathological Response in Patients Undergoing Surgery for Rectal Cancer

Horesh

Freund

Garoufalia

et al. 2022

Journal of Gastrointestinal Surgery

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Introduction Total neoadjuvant therapy (TNT) is a new therapeutic strategy in patients with rectal cancer. We examined the role of TNT, in addition to other pre-operative factors, as a predictor for pathologic complete response (pCR). Methods A retrospective analysis of all rectal cancer patients who underwent surgery between 2016 and 2021 was conducted. Patients were classified into two groups—pCR group and residual tumor group. Patient data were reviewed and entered into univariate and multivariate analyses to determine predictors of pCR. Results A total of 172 patients were treated with neoadjuvant therapy and underwent surgery during the study period. Sixty patients (34.9%) were treated with TNT while 112 (65.1%) were treated with traditional neoadjuvant chemoradiation. The overall pCR rate was 25.6% (44 patients), with 31.6% (19 patients) in patients who received TNT compared to 22.3% (25 patients) in patients who received neoadjuvant chemoradiation (NCRT). Univariate analysis of clinical and radiological factors correlated with pCR demonstrated no significant differences between the two groups in cT stage ( p = 0.46), cN stage ( p = 0.52), positive circumferential resection margin (CRM) ( p = 0.72), tumor location ( p = 0.35), symptomatic presentation ( p = 0.09), and anal sphincter involvement ( p = 0.68). Multivariate logistic analysis demonstrated that only pre-operative TNT (OR:2.35; 95% CI 1.06–5.25; p = 0.03) was predictive of pCR, while extramural vascular invasion (EMVI) was a predictor for lower rates of pCR (OR: 0.28; 95% CI 0.09–0.9; p = 0.03). Conclusion Rectal cancer patients undergoing TNT prior to surgery have a higher chance of developing a complete pathologic response. Evaluation of this therapy should be continued and extended to larger numbers of patients to see if the differences we observed are real.

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“…However, we can explain our results by the fact that, as was the case in the Stockholm region, more patients who were operated on during the first year of the pandemic presented to us with more locally advanced disease. 2 Conversely, Eklöv et al 1 noted that even in the COVID-19-free Ersta hospital, the rate of stoma creation significantly increased.…”

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confidence: 97%

“…Our own institutional experience showed that time from diagnosis to initiation of any treatment modality for rectal cancer was significantly prolonged in patients operated on during the first year of the pandemic. 2 Eklöv et al 1 also reported that the number of patients with colon cancer who received an ostomy during the pandemic nearly doubled compared with the same time period before the pandemic. In contrast, The COVIDSurg Collaborative, which analyzed 2073 patients in 40 countries operated on during the first wave of the pandemic, found that only 1.3% had a defunctioning stoma and only 3.0% had an end stoma instead of an anastomosis.…”

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confidence: 99%

“…consistent with other publications from around the world, including our own institutional experience. 2 Furthermore, a multicenter comparative cohort study 3 from Italy has reported that patients operated on during the first 8 months of the pandemic were more likely to be symptomatic, present with advanced stage disease, and have multiple liver metastases. These findings appear to be a direct result of delays in screening and diagnosis of colon and rectal cancer due to the restrictions imposed by the pandemic.…”

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confidence: 99%

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Trends in Colorectal Surgery During the COVID-19 Pandemic

Freund

Wexner

2022

JAMA Netw Open

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Ever since its widespread outbreak, the COVID-19 pandemic has challenged health care systems worldwide. Allocation of resources in an effort to contain the spread of the virus, along with the reluctance of many patients to seek health care because of restrictions and social isolation, have severely disrupted preventive screenings and cancer care worldwide. Beds were needed for critically ill patients with COVID-19, and staff were required to care for those patients. Therefore, a resource transfer led to a prohibition on elective surgery for varying lengths of time in every state in the US and elsewhere in the world, generally between March and May 2020. There have been numerous publications in the past 2 years reporting the association of the COVID-19 pandemic with the diagnosis and treatment of colon and rectal cancer.We read with great interest the comprehensive work by Eklöv et al 1 in which they retrospectively reviewed 1140 patients who received a diagnosis of colorectal cancer and were treated in 8 hospitals in the greater Stockholm region, the area in Sweden most affected by COVID-19. The authors compared 550 patients with colorectal cancer treated between March and August 2020 with a control group of 590 patients treated between March and August 2019. 1 The authors reported that more patients during the pandemic presented with advanced stage cancers, mostly a higher proportion of T4 tumors, compared with the control patients in 2019. This finding is + Related articleAuthor affiliations and article information are listed at the end of this article.

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The effect of the first year of the COVID-19 pandemic on sphincter preserving surgery for rectal cancer: A single referral center experience

Cited by 9 publications

References 29 publications

Impact of Covid-19 on gastrointestinal cancer surgery: A National Survey

Impact of Covid-19 on gastrointestinal cancer surgery: A National Survey

Total Neoadjuvant Therapy Is a Predictor for Complete Pathological Response in Patients Undergoing Surgery for Rectal Cancer

Trends in Colorectal Surgery During the COVID-19 Pandemic

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