Impact of Covid-19 on gastrointestinal cancer surgery: A National Survey

Delayed Diagnosis and Evolving Trends in Gastric Cancer During and After COVID-19: A Comparative Study of Staging, Helicobacter pylori Infection and Bleeding Risk in Western Romania

Background and Objectives: Gastric cancer (GC) remains a leading cause of cancer mortality worldwide, and the COVID-19 pandemic posed new barriers in diagnosis and management. This study aimed to assess whether pandemic-related healthcare disruptions resulted in more advanced GC stages at presentation. We additionally examined the role of Helicobacter pylori (H. pylori) across non-cardia GC (NCGC) versus cardia GC (CGC) and evaluated the risk factors of upper gastrointestinal (GI) bleeding. Methods: A retrospective cohort of 121 adult patients with GC was enrolled from a tertiary Gastroenterology Unit in Western Romania, spanning pre-pandemic (March 2018-February 2020), pandemic (March 2020-February 2022), and post-pandemic (March 2022-February 2024) periods. Demographic profiles, TNM staging, histopathology, H. pylori status, and clinical outcomes-including GI bleeding-were extracted from medical records. Results: An increase in advanced GC (Stage III-IVB) was noted in the post-pandemic period (69.4% vs. 53.3% pre-pandemic; p = 0.021). H. pylori positivity remained higher in NCGC (70.6%) compared to CGC (44.6%; overall p = 0.041); however, CGC cases showed a rise in H. pylori prevalence post-pandemic (36.4% to 55.6%). One-year mortality was driven by an advanced stage (hazard ratio [HR] = 2.74, p = 0.002), diagnosis during the COVID-19 pandemic (HR = 1.66, p = 0.010), and age ≥70 years (HR = 1.88, p = 0.043). Conclusions: Our findings demonstrate that delayed diagnostic endoscopy correlated with a higher proportion of advanced GC in the post-pandemic phase. H. pylori was strongly linked to NCGC, though CGC showed an increasing trend in H. pylori prevalence. Patients on antithrombotic agents faced increased GI bleeding risks.

Changes in Pancreatic Cancer Management and Surgical Treatment During the COVID-19 Pandemic

Background and Objectives: This study evaluated the impact of the COVID-19 pandemic on the surgical management of pancreatic ductal adenocarcinoma (PDAC) at a tertiary care hospital in Romania. The objective was to compare surgical volumes, tumor characteristics, and patient outcomes across three periods: pre-COVID, pandemic, and post-COVID. Materials and Methods: A retrospective analysis of 622 PDAC patients who underwent surgery between February 2018 and February 2024 was conducted. The key variables analyzed included tumor size, type of surgery (curative vs. palliative), use of neoadjuvant therapy, postoperative complications, and ICU monitoring, among others. Results: During the pandemic, there was a 25% decrease in surgical interventions compared the number performed during the pre-pandemic period, with a significant increase in the number of patients undergoing surgical intervention following neoadjuvant treatment (p = 0.009) in the post-pandemic period. Post-pandemic, surgical volumes increased by 10%, and tumor sizes were smaller (p = 0.029). Postoperative outcomes, such as complications, remained stable across the periods, but intensive care unit monitoring increased significantly during the pandemic and post-pandemic periods. Hospital stay durations were significantly shorter during and after the pandemic (p < 0.05). Conclusions: The COVID-19 pandemic led to delays in PDAC surgeries, but post-pandemic improvements in surgical volumes and early diagnosis are evident; however, further optimization of screening and treatment protocols is essential for improving patient outcomes.

An Exploratory Assessment of Pre-Treatment Inflammatory Profiles in Gastric Cancer Patients

Gastric cancer ranks as the fifth most common cancer, and the assessment of inflammatory biomarkers in these patients holds significant promise in predicting prognosis. Therefore, data from patients undergoing surgical intervention for gastric cancer over a 7-year period were analyzed. This study was retrospective and involved a preoperative investigation of six inflammatory parameters derived from complete blood counts. Statistical analysis revealed a significant increase in the leucocyte-to-monocyte ratio (LMR) (p = 0.048), along with a significant decrease in the number of lymphocytes and monocytes compared to patients with successful discharge. Taking into consideration patients undergoing emergency surgery, a significant increase in the LMR (p = 0.009), neutrophil-to-lymphocyte ratio (NLR) (p = 0.004), Aggregate Index of Systemic Inflammation (AISI) (p = 0.01), and Systemic Immune-Inflammation Index (SII) (p = 0.028) was observed. Regarding relapse, these patients exhibited significant increases in AISI (p = 0.032) and SII (p = 0.047). Inflammatory biomarkers represent a valuable tool in evaluating and predicting the prognosis of patients with gastric cancer.

Assessing the Influence of the COVID-19 Pandemic on Gastric Cancer Mortality Risk

BACKGROUND

The global impact of the coronavirus disease 2019 (COVID-19) pandemic on public health has been significant. Upper gastrointestinal endoscopy for screening and diagnosis decreased along with new gastric cancer (GC) diagnoses.

METHODS

This study assesses how the pandemic affected GC mortality using data from Hiroshima Prefecture, comparing mortality rates between patients diagnosed during the pandemic (2020 and 2021) and pre-pandemic (2018 and 2019) periods. The crude hazard ratios (HRs) and HRs adjusted for age, sex, clinical stage, treatment status, and travel distance to the nearest GC screening facility were estimated using Cox regression models. Subgroup and sensitivity analyses were also performed.

RESULTS

A total of 9571 patients were diagnosed, with 4877 eligible for follow-up. The median age was 74 years, and 69% were male. The median follow-up period was 157 days, with events per 1000 person-years at 278 and 374 in the pre-pandemic and pandemic periods, respectively (crude HR, 1.37; adjusted HR, 1.17). The sensitivity and subgroup analyses yielded consistent results.

CONCLUSIONS

The COVID-19 pandemic increased mortality risk in patients with GC. Further studies are required to observe long-term outcomes and identify the disparities contributing to the increased mortality risk.

COVID-19 Effect on Surgery for Gastrointestinal Malignancies: Have Operative Volumes Recovered?

BACKGROUND

COVID-19 disrupted elective operations, cancer screening, and routine medical care while simultaneously overwhelming hospital staff and supplies. Operations for gastrointestinal (GI) malignancies rely on endoscopic screening, staging, and neoadjuvant therapy (NAT), each of which was disrupted by the pandemic. The aim was to evaluate the effect of the COVID-19 pandemic on the US national rates of gastrointestinal oncologic operations.

METHODS

The Vizient Clinical Data Base® was queried for oncologic operations for esophageal, gastric, and colorectal malignancies with and without NAT from March 2019 to March 2022. Control chart analysis examined operative volume over time while Wilcoxon rank sum tests were used to compare mean monthly volume before and during the pandemic.

RESULTS

A total of 95,912 patients were identified over 36 months; 5.8% esophageal, 6.3% gastric, 77.5% colonic, and 10.4% rectal operations. Esophageal operative volume decreased for 9 months during the pandemic and was significantly lower during than before the pandemic (p=0.002). Gastric operations decreased for 10 months early in the pandemic, but rebounded so that after 2 years volumes were unchanged (p=0.49). Colonic operations experienced a sharp decrease for 4 months at the beginning of the pandemic, but volumes quickly increased and overall were unchanged (p=0.29). Rectal operations decreased for 13 months and were significantly lower during than before the pandemic (p=0.018). Oncologic operations for patients receiving NAT varied.

CONCLUSION

COVID-19 significantly disrupted the volume of gastrointestinal oncologic operations in the USA. Esophageal and rectal oncologic operations experienced prolonged and significant reductions while gastric and colonic oncologic operations transiently decreased but rebounded during the pandemic.

The Challenges of Gastric Cancer Surgery during the COVID-19 Pandemic

The aim of this study was to quantify the impact of the COVID-19 pandemic on the surgical treatment of patients with gastric cancer. Data from patients undergoing surgery for gastric cancer during the pandemic were analyzed and the results obtained were compared with the corresponding periods of 2016-2017 and 2018-2019. Various parameters were taken into consideration and their dynamics highlight significant changes in the pandemic year compared with the two pre-pandemic periods. Statistical analysis revealed a marked decrease in the number of surgeries performed during the pandemic (p < 0.001). Severe prognostic factors for gastric cancer, including weight loss and upper gastrointestinal hemorrhage, were associated with an increased number of postoperative fistulas, while emesis was statistically correlated with a more advanced cancer stage (p < 0.011). There was also a reduction in the total duration of hospitalization (p = 0.044) and postoperative hospitalization (p = 0.047); moreover, the mean duration of surgical intervention was higher during the pandemic (p = 0.044). These findings provide evidence for the significant changes in clinical and therapeutic strategies applied to patients undergoing surgery for gastric cancer during the study period. The ongoing pandemic has exerted a substantial and complex impact, the full extent of which remains yet to be fully comprehended.

The Influence of the COVID-19 Pandemic on Mortality of Patients Hospitalized in Surgical Services in Romania: A Cross-Sectional Study of a National Survey

Surgical practice worldwide has changed rapidly in response to the coronavirus disease 2019 (COVID-19) pandemic. The study aimed to analyze the impact of the COVID-19 pandemic on mortality, in hospitalized patients, in Romanian surgical services. We have developed our research on a national survey of the consecutive records of hospitalizations, surgical interventions and deaths performed in Romania between March and August 2020. Results show that 47 surgical departments responded to the request. The admissions in the period March–August 2020 represented 52% of that from the similar period of 2019. In the studied period, the share of surgical interventions in patients admitted to non-COVID-19 centres was 98.7%, respectively 78.2% in COVID-19 support hospitals (p < 0.05), and emergency interventions of 43.4% in non-COVID-19 hospitals, respectively 84.8% in COVID-19 support hospitals (p < 0.05). Overall mortality in this period was 5.82%, compared to 3.28% in a similar period in 2019, (p < 0.05). Postoperative mortality in COVID-19-positive patients was 19%. In conclusion, in the hospitals in Romania included in the survey, the overall mortality in the studied period was higher than in a similar period in 2019. In patients with COVID-19 positive, the recorded postoperative mortality was higher than overall mortality.