New Challenges in Surgical Approaches for Colorectal Cancer during the COVID-19 Pandemic
Source abstract
Abstract
(1) Background: The COVID-19 pandemic put a great burden on national healthcare systems, causing delays and disruptions in the medical care of non-COVID-19 patients. This paper aims to analyze the COVID-19 pandemic impact upon the quality of care in colorectal surgery. (2) Materials and Methods: We performed a retrospective study on the colorectal cancer cases operated in the Fourth Department of General Surgery, Emergency Hospital Bucharest Romania, over the period March 2020–February 2021 (pandemic group) vs. March 2019–February 2020 (non-pandemic group). (3) Results: The number of patients in the pandemic group decreased by 70% (36 vs. 118 patients), with lower accessibility from rural areas (11.1% vs. 37.2%, p = 0.035). Most cases in the pandemic group were emergencies (69% vs. 37.3%, p = 0.009), admitted for bowel obstruction (63.8% vs. 27.9%, p = 0.008). There was no in-hospital COVID-19 infection in patients operated for colorectal cancer. The 30-day mortality was significantly higher in the pandemic group (25% vs. 6.7%, p = 0.017), mostly due to septic shock (36.1% vs. 5%, p = 0.0001). (4) Conclusions: Colorectal cancer surgery may be performed safely during the COVID-19 pandemic, with strict adherence to the SARS-CoV-2 prevention protocols. However, the significant increase in colorectal cancers in the emergency was associated with worse outcomes and higher mortality during the COVID-19 pandemic.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: COVID-19 and healthcare impacts · COVID-19 Clinical Research Studies · Body Contouring and Surgery
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babes”, 030303 Bucharest, Romania
Second General Surgery Department, Emergency University Hospital Bucharest, Splaiul Independentei, nr. 169, 050098 Bucharest, Romania
Faculty of Medicine, General Surgery Department, ‘Ovidius’ University Constanta, 900470 Constanta, Romania
First Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
ICU II Toxicology, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
Faculty of Medicine, “Lucian Blaga” University Sibiu, 550024 Sibiu, Romania
Department of Surgery, Sibiu County Clinical Emergency Hospital, 550245 Sibiu, Romania
Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
References (48)
Show source-provided references
1. Robert, R., Kentish-Barnes, N., Boyer, A., Laurent, A., Azoulay, E., and Reignier, J. (2020). Ethical dilemmas due to the Covid-19 pandemic. Ann. Intensive Care, 10.10.1186/s13613-020-00702-7 ↗
2. Barach, P., Fisher, S.D., Adams, M.J., Burstein, G.R., Brophy, P.D., Kuo, D.Z., and Lipshultz, S.E. (2020). Disruption of healthcare: Will the COVID pandemic worsen non-COVID outcomes and disease outbreaks?. Prog. Pediatr. Cardiol., 59.10.1016/j.ppedcard.2020.101254 ↗
3. A conceptual model for assessing quality of care for patients boarding in the emergency department: Structure-process-outcome10.1111/j.1553-2712.2011.01033.x ↗
4. Chen, S.C., Lai, Y.H., and Tsay, S.L. (2020). Nursing Perspectives on the Impacts of COVID-19. J. Nurs. Res. (JNR), 28.10.1097/jnr.0000000000000389 ↗
5. Leo, C.G., Sabina, S., Tumolo, M.R., Bodini, A., Ponzini, G., Sabato, E., and Mincarone, P. (2021). Burnout Among Healthcare Workers in the COVID 19 Era: A Review of the Existing Literature. Front. Public Health, 9.10.3389/fpubh.2021.750529 ↗
6. Cancer statistics for the US Hispanic/Latino population, 202110.3322/caac.21695 ↗
7. Limb, M. (2021). Covid-19: Pandemic reduced life expectancy in most developed countries, study finds. BMJ, 375.10.1136/bmj.n2750 ↗
8. Araujo, S.E.A., Leal, A., Centrone, A.F.Y., Teich, V.D., Malheiro, D.T., Cypriano, A.S., Cendoroglo Neto, M., and Klajner, S. (2020). Impact of COVID-19 pandemic on care of oncological patients: Experience of a cancer center in a Latin American pandemic epicenter. Einstein, 19.10.31744/einstein_journal/2021AO6282 ↗
9. Impact of the coronavirus disease 2019 pandemic on cancer treatment: The patients’ perspective10.1016/j.ejca.2020.06.019 ↗
10. Estimating the impact of the COVID-19 pandemic on diagnosis and survival of five cancers in Chile from 2020 to 2030: A simulation-based analysis10.1016/S1470-2045(21)00426-5 ↗
11. (2022, January 20). Impactul Pandemiei COVID-19. Available online: https://health-observatory.ro/wp-content/uploads/2020/10/Raport_ORS-impact_pandemie_cronici_2020.pdf.
12. Serban, D., Socea, B., Badiu, C.D., Tudor, C., Balasescu, S.A., Dumitrescu, D., Trotea, A.M., Spataru, R.I., Vancea, G., and Dascalu, A.M. (2021). Acute surgical abdomen during the COVID-19 pandemic: Clinical and therapeutic challenges. Exp. Ther. Med., 21.10.3892/etm.2021.9950 ↗
13. Collateral damage: The impact on outcomes from cancer surgery of the COVID-19 pandemic10.1016/j.annonc.2020.05.009 ↗
14. Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: A modelling study10.1016/S1470-2045(20)30392-2 ↗
15. Emergency treatment of complicated colorectal cancer10.2147/CMAR.S158335 ↗
16. Cause of death among patients with colorectal cancer: A population-based study in the United States
17. COVID-CIR Collaborative Group Members of the COVID-CIR Collaborative Group. Analysis of outcomes of emergency general and gastrointestinal surgery during the COVID-19 pandemic10.1093/bjs/znab299 ↗
18. Haffner, M.R., Le, H.V., Saiz, A.M., Han, G., Fine, J., Wolinsky, P., and Klineberg, E.O. (2021). Postoperative In-Hospital Morbidity and Mortality of Patients With COVID-19 Infection Compared With Patients Without COVID-19 Infection. JAMA Netw. Open, 4.10.1001/jamanetworkopen.2021.5697 ↗
19. Serban, D., Smarandache, C.G., Tudor, C., Duta, L.N., Dascalu, A.M., and Aliuș, C. (2020). Laparoscopic Surgery in COVID-19 Era—Safety and Ethical Issues. Diagnostics, 10.10.3390/diagnostics10090673 ↗
20. COVID-19: Impact on colorectal surgery10.1111/codi.15112 ↗
21. Delayed diagnosis of ascending colon mucinous adenocarcinoma with local abscess as primary manifestation: Report of three cases10.12998/wjcc.v9.i26.7901 ↗
22. Long-term outcomes and prognostic factors of young patients with mucinous and signet-ring cell colorectal cancer10.5114/aoms.2020.93342 ↗
23. Institute of Medicine (US) Committee on Quality of Health Care in America (2001). 2, Improving the 21st-century Health Care System. Crossing the Quality Chasm: A New Health System for the 21st Century, National Academies Press (US). Available online: https://www.ncbi.nlm.nih.gov/books/NBK222265/.
24. COVID-19 and the emergency presentation of colorectal cancer10.1111/codi.15662 ↗
25. Kopel, J., Ristic, B., Brower, G.L., and Goyal, H. (2022). Global Impact of COVID-19 on Colorectal Cancer Screening: Current Insights and Future Directions. Medicina, 58.10.3390/medicina58010100 ↗
26. Oncological colorectal surgery during the COVID-19pandemic-a national survey10.1007/s00384-020-03697-6 ↗
27. Maintaining quality of care in colorectal cancer surgery during the COVID-19 pandemic10.1002/bjs.11866 ↗
28. Downs, J.S., Wilkinson, M.J., Gyorki, D.E., and Speakman, D. (2020). Providing cancer surgery in the COVID-19 crisis. Br. J. Surg., 107.10.1002/bjs.11693 ↗
29. Obstructive left colon cancer should be managed by using a subtotal colectomy instead of colonic stenting10.3393/ac.2016.32.6.215 ↗
30. Surgical Management of Complicated Colon Cancer10.1055/s-0035-1564621 ↗
31. Association of Coloproctology of Great Britain, Ireland The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer10.1097/01.sla.0000130723.81866.75 ↗
32. Mortality after emergency treatment of colorectal cancer and associated risk factors—a nationwide cohort study10.1007/s00384-018-3172-x ↗
33. Emergency management of perforated colon cancers: How aggressive should we be?10.1007/s11605-011-1674-8 ↗
34. Impact of the COVID-19 Pandemic on Colorectal Cancer Diagnosis and Treatment: A Systematic Review
35. Impact of COVID-19 Pandemic on Colorectal Cancer Screening Program10.1016/j.clcc.2020.07.006 ↗
36. Cancer diagnostic rates during the 2020 ‘lockdown’, due to COVID-19 pandemic, compared with the 2018–2019: An audit study from cellular pathology10.1136/jclinpath-2020-206833 ↗
37. Impact of COVID-19 on colorectal cancer early diagnosis pathway: Retrospective cohort study10.1093/bjs/znaa122 ↗
38. Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: A national endoscopy database analysis10.1136/gutjnl-2020-322179 ↗
39. Impact of the COVID-19 pandemic during Spain’s state of emergency on the diagnosis of colorectal cancer10.1002/jso.26263 ↗
40. Sobrado, L.F., Nahas, C.S.R., Marques, C.F.S., Cotti, G.C.C., Imperiale, A.R., Averbach, P., Meira Júnior, J.D., Horvat, N., Ribeiro-Júnior, U., and Cecconello, I. (2021). Is it Safe to Perform Elective Colorectal Surgical Procedures during the COVID-19 Pandemic? A Single Institution Experience with 103 Patients. Clinics, 76.10.6061/clinics/2021/e2507 ↗
41. Xu, Y., Huang, Z.H., Zheng, C.Z.L., Li, C., Zhang, Y.Q., Guo, T.A., Liu, F.Q., and Xu, Y. (2021). The impact of COVID-19 pandemic on colorectal cancer patients: A single-center retrospective study. BMC Gastroenterol., 21.10.1186/s12876-021-01768-8 ↗
42. Colorectal Cancer Surgery During the COVID-19 Pandemic: A Single Center Experience10.21873/invivo.12382 ↗
43. Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer
44. Dutch Snapshot Research Group Comparison of Decompressing Stoma vs Stent as a Bridge to Surgery for Left-Sided Obstructive Colon Cancer10.1001/jamasurg.2019.5466 ↗
45. Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: Results of a systematic review and meta-analysis of randomized controlled trials10.1016/j.gie.2017.03.1542 ↗
46. Cirocchi, R., Arezzo, A., Sapienza, P., Crocetti, D., Cavaliere, D., Solaini, L., Ercolani, G., Sterpetti, A.V., Mingoli, A., and Fiori, E. (2021). Current Status of the Self-Expandable Metal Stent as a Bridge to Surgery Versus Emergency Surgery in Colorectal Cancer: Results from an Updated Systematic Review and Meta-Analysis of the Literature. Medicina, 57.10.3390/medicina57030268 ↗
47. Economic analysis of medical management applied for left colostomy
48. Morino, M., Arezzo, A., Farnesi, F., and Forcignanò, E. (2021). Colonic Stenting in the Emergency Setting. Medicina, 57.10.3390/medicina57040328 ↗