BACKGROUND: The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during the COVID-19 pandemic, which are currently unclear. OBJECTIVE: This study aimed to evaluate the changes in care and short-term outcomes of surgical patients with gynecologic cancers during the COVID-19 pandemic. We hypothesized that the COVID-19 pandemic had led to a delay in surgical cancer care, especially in patients who required more extensive surgery, and such delay had an impact on cancer outcomes. STUDY DESIGN: This was a multicenter, international, prospective cohort study. Consecutive patients with gynecologic cancers who were initially planned for nonpalliative surgery, were recruited from the date of first COVID-19-related admission in each participating center for 3 months. The follow-up period was 3 months from the time of the multidisciplinary tumor board decision to operate. The primary outcome of this analysis is the incidence of pandemic-related changes in care. The secondary outcomes included 30-day perioperative mortality and morbidity and a composite outcome of unresectable disease or disease progression, emergency surgery, and death. RESULTS: We included 3973 patients (3784 operated and 189 nonoperated) from 227 centers in 52 countries and 7 world regions who were initially planned to have cancer surgery. In 20.7% (823/3973) of the patients, the standard of care was adjusted. A significant delay (>8 weeks) was observed in 11.2% (424/3784) of patients, particularly in those with ovarian cancer (213/1355; 15.7%; P<.0001). This delay was associated with a composite of adverse outcomes, including disease progression and death (95/424; 22.4% vs 601/3360; 17.9%; P<1/4>.024) compared with those who had operations within 8 weeks of tumor board decisions. One in 13 (189/2430; 7.9%) did not receive their planned operations, in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of multidisciplinary team board decision for surgery. Only 22 of the 3778 surgical patients (0.6%) acquired perioperative SARS-CoV-2 infections; they had a longer postoperative stay (median 8.5 vs 4 days; P<.0001), higher predefined surgical morbidity (14/22; 63.6% vs 717/3762; 19.1%; P<.0001) and mortality (4/22; 18.2% vs 26/3762; 0.7%; P<.0001) rates than the uninfected cohort. CONCLUSION: One in 5 surgical patients with gynecologic cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations, and coordinated mitigating strategies are urgently needed.

Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study / Fotopoulou, Christina; Khan, Tabassum; Bracinik, Juraj; Glasbey, James; Abu-Rustum, Nadeem; Chiva, Luis; Fagotti, Anna; Fujiwara, Keiichi; Ghebre, Rahel; Gutelkin, Murat; Konney, Thomas O; Ng, Joseph; Pareja, Rene; Kottayasamy Seenivasagam, Rajkumar; Sehouli, Jalid; Surappa, Shylasree T S; Bhangu, Aneel; Leung, Elaine; Sundar, Sudha; A, Belvedere; P, Bernante; P, Bertoglio; S, Boussedra; E, Brunocilla; M, Cervellera; M, Cescon; R, Cipriani; G, Cisternino; Crescenzo E, De; Iaco P, De; Gaudio M, Del; G, Dondi; M, Droghetti; G, Germinario; A, Gori; F, Frio; E, Jovine; Bianchi F, Mineo; D, Morezzi; J, Neri; D, Parlanti; Perrone, A.M.; AP, Pezzuto; M, Pignatti; V, Pinto; G, Poggioli; M, Ravaioli; M, Rottoli; V, Tonini; L, Sartarelli. - In: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. - ISSN 0002-9378. - ELETTRONICO. - 227:5(2022), pp. 1-25. [10.1016/j.ajog.2022.06.052]

Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study

P, Bernante;Iaco P, De;E, Jovine;Perrone, A. M.;G, Poggioli;M, Ravaioli;M, Rottoli;V, Tonini;L, Sartarelli
2022

Abstract

BACKGROUND: The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during the COVID-19 pandemic, which are currently unclear. OBJECTIVE: This study aimed to evaluate the changes in care and short-term outcomes of surgical patients with gynecologic cancers during the COVID-19 pandemic. We hypothesized that the COVID-19 pandemic had led to a delay in surgical cancer care, especially in patients who required more extensive surgery, and such delay had an impact on cancer outcomes. STUDY DESIGN: This was a multicenter, international, prospective cohort study. Consecutive patients with gynecologic cancers who were initially planned for nonpalliative surgery, were recruited from the date of first COVID-19-related admission in each participating center for 3 months. The follow-up period was 3 months from the time of the multidisciplinary tumor board decision to operate. The primary outcome of this analysis is the incidence of pandemic-related changes in care. The secondary outcomes included 30-day perioperative mortality and morbidity and a composite outcome of unresectable disease or disease progression, emergency surgery, and death. RESULTS: We included 3973 patients (3784 operated and 189 nonoperated) from 227 centers in 52 countries and 7 world regions who were initially planned to have cancer surgery. In 20.7% (823/3973) of the patients, the standard of care was adjusted. A significant delay (>8 weeks) was observed in 11.2% (424/3784) of patients, particularly in those with ovarian cancer (213/1355; 15.7%; P<.0001). This delay was associated with a composite of adverse outcomes, including disease progression and death (95/424; 22.4% vs 601/3360; 17.9%; P<1/4>.024) compared with those who had operations within 8 weeks of tumor board decisions. One in 13 (189/2430; 7.9%) did not receive their planned operations, in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of multidisciplinary team board decision for surgery. Only 22 of the 3778 surgical patients (0.6%) acquired perioperative SARS-CoV-2 infections; they had a longer postoperative stay (median 8.5 vs 4 days; P<.0001), higher predefined surgical morbidity (14/22; 63.6% vs 717/3762; 19.1%; P<.0001) and mortality (4/22; 18.2% vs 26/3762; 0.7%; P<.0001) rates than the uninfected cohort. CONCLUSION: One in 5 surgical patients with gynecologic cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations, and coordinated mitigating strategies are urgently needed.
2022
Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study / Fotopoulou, Christina; Khan, Tabassum; Bracinik, Juraj; Glasbey, James; Abu-Rustum, Nadeem; Chiva, Luis; Fagotti, Anna; Fujiwara, Keiichi; Ghebre, Rahel; Gutelkin, Murat; Konney, Thomas O; Ng, Joseph; Pareja, Rene; Kottayasamy Seenivasagam, Rajkumar; Sehouli, Jalid; Surappa, Shylasree T S; Bhangu, Aneel; Leung, Elaine; Sundar, Sudha; A, Belvedere; P, Bernante; P, Bertoglio; S, Boussedra; E, Brunocilla; M, Cervellera; M, Cescon; R, Cipriani; G, Cisternino; Crescenzo E, De; Iaco P, De; Gaudio M, Del; G, Dondi; M, Droghetti; G, Germinario; A, Gori; F, Frio; E, Jovine; Bianchi F, Mineo; D, Morezzi; J, Neri; D, Parlanti; Perrone, A.M.; AP, Pezzuto; M, Pignatti; V, Pinto; G, Poggioli; M, Ravaioli; M, Rottoli; V, Tonini; L, Sartarelli. - In: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. - ISSN 0002-9378. - ELETTRONICO. - 227:5(2022), pp. 1-25. [10.1016/j.ajog.2022.06.052]
Fotopoulou, Christina; Khan, Tabassum; Bracinik, Juraj; Glasbey, James; Abu-Rustum, Nadeem; Chiva, Luis; Fagotti, Anna; Fujiwara, Keiichi; Ghebre, Rahel; Gutelkin, Murat; Konney, Thomas O; Ng, Joseph; Pareja, Rene; Kottayasamy Seenivasagam, Rajkumar; Sehouli, Jalid; Surappa, Shylasree T S; Bhangu, Aneel; Leung, Elaine; Sundar, Sudha; A, Belvedere; P, Bernante; P, Bertoglio; S, Boussedra; E, Brunocilla; M, Cervellera; M, Cescon; R, Cipriani; G, Cisternino; Crescenzo E, De; Iaco P, De; Gaudio M, Del; G, Dondi; M, Droghetti; G, Germinario; A, Gori; F, Frio; E, Jovine; Bianchi F, Mineo; D, Morezzi; J, Neri; D, Parlanti; Perrone, A.M.; AP, Pezzuto; M, Pignatti; V, Pinto; G, Poggioli; M, Ravaioli; M, Rottoli; V, Tonini; L, Sartarelli
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/919034
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