학술논문
Outcomes from elective colorectal cancer surgery during the SARS‐CoV‐2 pandemic
Document Type
article
Author
Glasbey, James C; Nepogodiev, Dmitri; Simoes, Joana FF; Omar, Omar M; Venn, Mary L; Evans, Jonathan P; Futaba, Kaori; Knowles, Charles H; Minaya‐Bravo, Ana; Mohan, Helen; Chand, Manish; Pockney, Peter; Di Saverio, Salomone; Smart, Neil; Vallance, Abigail; Vimalachandran, Dale; Wilkin, Richard JW; Siaw‐Acheampong, Kwabena; Benson, Ruth A; Bywater, Edward; Chaudhry, Daoud; Dawson, Brett E; Gujjuri, Rohan R; Heritage, Emily; Jones, Conor S; Kamarajah, Sivesh K; Khatri, Chetan; Khaw, Rachel A; Keatley, James M; Knight, Andrew; Lawday, Samuel; Mann, Harvinder S; Marson, Ella J; McLean, Kenneth A; Mckay, Siobhan C; Mills, Emily C; Pellino, Gianluca; Picciochi, Maria; Taylor, Elliott H; Tiwari, Abhinav; Trout, Isobel M; Smart, Neil J; Gallo, Gaetano; Moug, Susan; Pata, Francesco; Vimalchandran, Dale; Abbott, Tom EF; Abukhalaf, Sadi; Adamina, Michel; Ademuyiwa, Adesoji O; Agarwal, Arnav; Akkulak, Murat; 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; Beard, David; Blanco‐Colino, Ruth; Brar, Amanpreet; Breen, Kerry A; Bretherton, Chris; Lima Buarque, Igor; Burke, Joshua; Caruana, Edward J; Chaar, Mohammad; Chakrabortee, Sohini; Christensen, Peter; Cox, Daniel; Cukier, Moises; Cunha, Miguel F; Davidson, Giana H; Desai, Anant; Drake, Thomas M; Edwards, John G; Elhadi, Muhammed; Emile, Sameh; Farik, Shebani; Fiore, Marco; Edward Fitzgerald, J; Ford, Samuel; Garmanova, Tatiana
Source
Colorectal Disease. 23(3)
Subject
Language
Abstract
AimThis 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.MethodThis 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.ResultsFrom 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%).ConclusionSurgeons 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.