Trends in Treatment of Colorectal Cancer and Short-term Outcomes During the First Wave of the COVID-19 Pandemic in Sweden

Abstract

Key Points Question Did the treatment of colorectal cancer in Stockholm, Sweden, change during the COVID-19 pandemic? Findings In this cohort study of 1140 patients with colorectal cancer from the Swedish Colorectal Cancer Registry, the proportion of patients with colon cancer treated with ostomy almost doubled, from 17% in March to August 2019 to 30% in March to August 2020; short-term complications and time to surgery remained unchanged. Meaning These findings suggest that changes in surgical behavior occurred during the COVID-19 pandemic, most likely aiming to reduce complications and intensive care unit care.

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

“…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.…”

Trends in Colorectal Surgery During the COVID-19 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. 7 This finding is interesting and may, as the authors mention, 1 indicate that our Swedish colleagues may have decided during that time to opt for the procedure with the lowest risk of complications to avoid potential complications that may overload their overwhelmed intensive care units. This finding is another example of how colorectal surgeons had to adapt their practices and surgical decision-making to cope with the new reality set by the pandemic.…”

“…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…”

“…In addition to potential adverse outcomes to the patients, such as greater likelihood of an ostomy, hospital staff also experienced negative sequelae. One example of the hazards of the pandemic was the significant decrease in the participation of residents in colorectal surgery described by Eklöv et al 1 Clearly, physical distancing hindered surgical education; operative volumes are estimated to have been decreased by over 50% during the first wave of the pandemic. As we have learned that we can safely operate during the pandemic, we have also realized that resident education need not be compromised.…”

“…We hope that these lessons learned will become practice used during the next pandemic or future waves of COVID-19. It would be interesting if Eklöv et al 1 Corresponding Author: Steven D. Wexner, MD, Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331 (wexners@ccf.org).…”