Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
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Date
2020-11
Authors
Li, Elizabeth
Glasbey, JC
Nepogodiev, D
Simoes, JFF
Omar, OM
Venn, ML
Evans, JP
Futaba, K
Knowles, CH
Minaya-Bravo, A
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley
Abstract
Aim: This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic.
Method: This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data.
Results: From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58-14.06), postoperative SARS-CoV-2 (16.90, 7.86-36.38), male sex (2.46, 1.01-5.93), age >70 years (2.87, 1.32-6.20) and advanced cancer stage (3.43, 1.16-10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%).
Conclusion: Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks.
Description
Scholarly article
Keywords
COVID-19 , SARS-CoV-2 , Cancer , colon cancer , Rectal cancer , surgical oncology , Research Subject Categories::MEDICINE::Surgery
Citation
COVIDSurg Collaborative. Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic. Colorectal Dis. 2020 Nov 15:10.1111/codi.15431. doi: 10.1111/codi.15431. Epub ahead of print. PMID: 33191669; PMCID: PMC7753519.