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.

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic / Glasbey, J.C., Nepogodiev, D., Simoes, J.F.F., Omar, O.M., Venn, M.L., Evans, J.P., Futaba, K., Knowles, C.H., Minaya-Bravo, A., Mohan, H., Chand, M., Pockney, P.G., Di Saverio, S., Smart, N., Vallance, A., Vimalachandran, D., Wilkin, R.J.W., Siaw-Acheampong, K., Benson, R.A., Bywater, E., et al.. - In: COLORECTAL DISEASE. - ISSN 1462-8910. - 23:3(2021), pp. 732-749. [10.1111/codi.15431]

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

De Palma G. D.;Luglio G.
Membro del Collaboration Group
;
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 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.
2021
Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic / Glasbey, J.C., Nepogodiev, D., Simoes, J.F.F., Omar, O.M., Venn, M.L., Evans, J.P., Futaba, K., Knowles, C.H., Minaya-Bravo, A., Mohan, H., Chand, M., Pockney, P.G., Di Saverio, S., Smart, N., Vallance, A., Vimalachandran, D., Wilkin, R.J.W., Siaw-Acheampong, K., Benson, R.A., Bywater, E., et al.. - In: COLORECTAL DISEASE. - ISSN 1462-8910. - 23:3(2021), pp. 732-749. [10.1111/codi.15431]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/869669
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