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Fotopoulou C, Khan T, Bracinik J, Glasbey J, Abu-Rustum N, Chiva L, Fagotti A, Fujiwara K, Ghebre R, Gutelkin M, Konney TO, Ng J, Pareja R, Kottayasamy Seenivasagam R, Sehouli J, Surappa ST, Bhangu A, Leung E, Sundar S. Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study. Am J Obstet Gynecol 2022; 227:735.e1-735.e25. [PMID: 35779589 PMCID: PMC9242690 DOI: 10.1016/j.ajog.2022.06.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 01/10/2023]
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=.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.
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Affiliation(s)
- Christina Fotopoulou
- Department of Surgery and Cancer, Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - Tabassum Khan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Juraj Bracinik
- Particle Physics Group, School of Physics and Astronomy, University of Birmingham, Birmingham, United Kingdom
| | - James Glasbey
- National Institute for Health and Care Research Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
| | | | - Luis Chiva
- University Clinic of Navarra, Madrid, Spain
| | - Anna Fagotti
- Division Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center and on behalf of GOTIC and APGOT, Saitama, Japan
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology and Women's Health and Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Murat Gutelkin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Thomas O. Konney
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Joseph Ng
- Gynecologic Oncology Department, National University Cancer Institute, Singapore, Singapore
| | - Rene Pareja
- Gynecologic Oncology Unit, National Cancer Institute, Bogotá and Astorga Oncology Clinic, Medellín, Colombia
| | | | - Jalid Sehouli
- Department of Gynecology with Center of Surgical Oncology, Charité Campus Virchow Klinikum, Berlin, Germany
| | | | - Aneel Bhangu
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
| | - Elaine Leung
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom,Corresponding author: Sudha Sundar, MD, PhD
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Ozturk UK, Akis S, Keles E, Alınca CM, Api M. Single centre experience of 800 gynaecologic oncology cases in 2020: influence of pandemy on cancer surgeries. J OBSTET GYNAECOL 2022; 42:2302-2306. [PMID: 35476608 DOI: 10.1080/01443615.2022.2049716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We aimed to evaluate the gynaecological oncology surgeries in the COVID-19 pandemic. A total of 800 operations performed between January and December 2020 were retrieved. Since the COVID-19 pandemic affected operations as of April 1 2020, we compared the cases of the last nine months of the year with the first three months. Of the operations, 265 (33.1%) were performed between January and March and 535 (66.9%) between April and December. Of 168 malignant operations; 78 (46%) were uterine cancer, 58 (35%) ovarian cancer, 28 (17%) cervical cancer and four (2%) vulvar cancer. If we compared the last nine months of the year with the first three months, a significant increase was observed in the rates of malignant and premalignant, while a significant decrease was detected in benign operations (p<.001). Gynaecological oncology surgeries performed with open or laparoscopic approaches during the COVID-19 pandemic should continue by taking preventive measures. Impact StatementWhat is already known on this subject? During the COVID-19 pandemic, many international associations and organisations recommended the suspension of elective surgeries. It is still controversial whether the gynaecologic oncology surgical procedures to be performed in this unprecedented time should be laparoscopic or laparotomic.What do the results of this study add? The malignant and premalignant gynaecological oncology surgeries should be safely performed laparoscopically or by laparotomy in the COVID-19 pandemic.What are the implications of these findings for clinical practice and/or further research? Gynaecologic oncology surgeries can be safely performed by attaching appropriate personal protective equipment procedures with pre-operative COVID-19 PCR testing in the COVID-19 era.
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Affiliation(s)
- Ugur Kemal Ozturk
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Serkan Akis
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Esra Keles
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Cihat Murat Alınca
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Murat Api
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
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