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 colon or rectal cancer resection, 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 a pre-pandemic 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. 30-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-CoV2 (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 an 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 to pre-pandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%), 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 organisational risks.

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[10.1111/codi.15431]

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

Cervellera, M;Gori, A;Sartarelli, L;Tonini, V;Belvedere, A;Bernante, P;Jovine, E;Neri, J;Parlanti, D;Pezzuto, AP;Poggioli, G;Rottoli, M;Tanzanu, M;Violante, T;
2021

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 colon or rectal cancer resection, 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 a pre-pandemic 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. 30-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-CoV2 (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 an 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 to pre-pandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%), 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 organisational risks.
2021
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FF Simoes, Joana; Trout, Isobel M; Venn, Mary L; JW Wilkin, Richard; Bhangu, Aneel; Glasbey, James C; Smart, Neil J; Minaya‐Bravo, Ana; Evans, Jonathan P; Moug, Susan J; Vimalchandran, Dale; Vallance, Abigail; Pockney, Peter; Di Saverio, Salomone; FF Simoes, Joana; EF Abbott, Tom; Adamina, Michel; Ademuyiwa, Adesoji O; Agarwal, Arnav; Alameer, Ehab; Alderson, Derek; Alakaloko, Felix; Albertsmeiers, Markus; Alser, Osaid; Alshaar, Muhammad; Alshryda, Sattar; Arnaud, Alexis P; Magne Augestad, Knut; Ayasra, Faris; Azevedo, José; Bankhead‐Kendall, Brittany K; Barlow, Emma; Benson, Ruth A; Blanco‐Colino, Ruth; Brar, Amanpreet; Minaya‐Bravo, Ana; Breen, Kerry A; Bretherton, Chris; Lima Buarque, Igor; Burke, Joshua; Caruana, Edward J; Abou Chaar, Mohamad K.; Chakrabortee, Sohini; Christensen, Peter; Cox, Daniel; Cukier, Moises; Cunha, Miguel F; Davidson, Giana H; Desai, Anant; Di Saverio, Salomone; Drake, Thomas M; Edwards, John G; Elhadi, Muhammed; Emile, Sameh; Farik, Shebani; Fiore, Marco; 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[10.1111/codi.15431]
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