New Challenges in Surgical Approaches for Colorectal Cancer during the COVID-19 Pandemic

(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.

[1]  H. Goyal,et al.  Global Impact of COVID-19 on Colorectal Cancer Screening: Current Insights and Future Directions , 2022, Medicina.

[2]  H. Salehiniya,et al.  Impact of the COVID-19 Pandemic on Colorectal Cancer Diagnosis and Treatment: a Systematic Review , 2021, Journal of Gastrointestinal Cancer.

[3]  M. Limb Covid-19: Pandemic reduced life expectancy in most developed countries, study finds , 2021, BMJ.

[4]  A. Bodini,et al.  Burnout Among Healthcare Workers in the COVID 19 Era: A Review of the Existing Literature , 2021, Frontiers in Public Health.

[5]  A. Jemal,et al.  Cancer statistics for the US Hispanic/Latino population, 2021 , 2021, CA: a cancer journal for clinicians.

[6]  C. Tebé,et al.  Analysis of outcomes of emergency general and gastrointestinal surgery during the COVID-19 pandemic. , 2021, The British journal of surgery.

[7]  Shangzhi Han,et al.  Delayed diagnosis of ascending colon mucinous adenocarcinoma with local abscess as primary manifestation: Report of three cases , 2021, World journal of clinical cases.

[8]  D. Serban,et al.  Acute surgical abdomen during the COVID-19 pandemic: Clinical and therapeutic challenges. , 2021, Experimental and therapeutic medicine.

[9]  M. Morino,et al.  Colonic Stenting in the Emergency Setting , 2021, Medicina.

[10]  E. Klineberg,et al.  Postoperative In-Hospital Morbidity and Mortality of Patients With COVID-19 Infection Compared With Patients Without COVID-19 Infection , 2021, JAMA network open.

[11]  J. Torkington,et al.  COVID‐19 and the emergency presentation of colorectal cancer , 2021, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[12]  Y. Salama,et al.  Impact of COVID-19 on colorectal cancer early diagnosis pathway: retrospective cohort study , 2021, The British journal of surgery.

[13]  I. Cecconello,et al.  Is it Safe to Perform Elective Colorectal Surgical Procedures during the COVID-19 Pandemic? A Single Institution Experience with 103 Patients , 2021, Clinics.

[14]  A. Arezzo,et al.  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 , 2021, Medicina.

[15]  Ye Xu,et al.  The impact of COVID-19 pandemic on colorectal cancer patients: a single-center retrospective study , 2020, BMC Gastroenterology.

[16]  S. Scabini,et al.  Colorectal Cancer Surgery During the COVID-19 Pandemic: A Single Center Experience , 2021, In Vivo.

[17]  Lei Zhao,et al.  Cause of death among patients with colorectal cancer: a population-based study in the United States , 2020, Aging.

[18]  M. Ederra,et al.  Impact of the COVID‐19 pandemic during Spain's state of emergency on the diagnosis of colorectal cancer , 2020, Journal of Surgical Oncology.

[19]  D. Serban,et al.  Laparoscopic Surgery in COVID-19 Era—Safety and Ethical Issues , 2020, Diagnostics.

[20]  D. Chan,et al.  Maintaining quality of care in colorectal cancer surgery during the COVID-19 pandemic , 2020, The British journal of surgery.

[21]  L. Miglioresi,et al.  Impact of COVID-19 Pandemic on Colorectal Cancer Screening Program , 2020, Clinical Colorectal Cancer.

[22]  R. Grützmann,et al.  Oncological colorectal surgery during the COVID-19pandemic—a national survey , 2020, International Journal of Colorectal Disease.

[23]  A. Dingemans,et al.  Impact of the COVID-19 pandemic on cancer treatment: the patients’ perspective , 2020, European Journal of Cancer.

[24]  L. Sharp,et al.  Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis , 2020, Gut.

[25]  G. Ferrara,et al.  Cancer diagnostic rates during the 2020 ‘lockdown’, due to COVID-19 pandemic, compared with the 2018–2019: an audit study from cellular pathology , 2020, Journal of Clinical Pathology.

[26]  É. Azoulay,et al.  Ethical dilemmas due to the Covid-19 pandemic , 2020, Annals of Intensive Care.

[27]  Gale R. Burstein,et al.  Disruption of healthcare: Will the COVID pandemic worsen non-COVID outcomes and disease outbreaks? , 2020, Progress in Pediatric Cardiology.

[28]  R. Houlston,et al.  Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic , 2020, Annals of Oncology.

[29]  D. Gyorki,et al.  Providing cancer surgery in the COVID‐19 crisis , 2020, The British journal of surgery.

[30]  H. Gilshtein,et al.  COVID‐19: impact on colorectal surgery , 2020, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[31]  Yuzhe Chen,et al.  Long-term outcomes and prognostic factors of young patients with mucinous and signet-ring cell colorectal cancer , 2020, Archives of medical science : AMS.

[32]  E. Consten,et al.  Comparison of Decompressing Stoma vs Stent as a Bridge to Surgery for Left-Sided Obstructive Colon Cancer. , 2020, JAMA surgery.

[33]  J. Søgaard,et al.  Mortality after emergency treatment of colorectal cancer and associated risk factors—a nationwide cohort study , 2018, International Journal of Colorectal Disease.

[34]  G. Sawada,et al.  Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer. , 2017, Oncology letters.

[35]  M. Morino,et al.  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 trials. , 2017, Gastrointestinal endoscopy.

[36]  H. Chun,et al.  Obstructive Left Colon Cancer Should Be Managed by Using a Subtotal Colectomy Instead of Colonic Stenting , 2016, Annals of coloproctology.

[37]  S. Lee-Kong,et al.  Surgical Management of Complicated Colon Cancer , 2015, Clinics in Colon and Rectal Surgery.

[38]  D. Șerban,et al.  Economic analysis of medical management applied for left colostomy. , 2013, Chirurgia.

[39]  M. Zielinski,et al.  Emergency Management of Perforated Colon Cancers: How Aggressive Should We Be? , 2011, Journal of Gastrointestinal Surgery.

[40]  Carlos A Camargo,et al.  A conceptual model for assessing quality of care for patients boarding in the emergency department: structure-process-outcome. , 2011, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[41]  Michael R. Thompson,et al.  The Association of Coloproctology of Great Britain and Ireland Study of Large Bowel Obstruction Caused by Colorectal Cancer , 2004, Annals of surgery.