Evaluation of treatment delays in hepatopancreatico-biliary surgery during the first COVID-19 wave

Delayed surgery during the Covid-19 pandemic did not affect long-term outcomes of pancreatic adenocarcinoma

BACKGROUND

During the Covid-19 pandemic cancer surgery was severely affected due to relocation of healthcare resources and the resulting restructuring of cancer pathways. Although this potentially affected rapidly progressing malignancies like pancreatic cancer the most, little is known about long-term outcomes following pancreatectomy.

MATERIALS AND METHODS

Survival data from two pancreatic surgery centres in the UK was analysed with patients being compared across pre-pandemic (C19-) and intra-pandemic (C19+) groups. Demographic, pathological and surgical pathway parameters were evaluated with multivariate analysis and propensity score matching.

RESULTS

Out of 123 patients, 60 had surgery during the pandemic. The main strategy to reduce disruptions to pancreatic surgery was relocation of services to private sector facilities without emergency medicine departments. Although time to surgery was delayed by almost 20 days during the pandemic, there were no significant differences in overall survival at 22 months vs. 24 months or disease free survival at 15 months vs. 16 months for the C19+ and C19- groups, respectively. Adjuvant chemotherapy, Charlson comorbidity score, tumour stage and resection margin status were found to be independent predictors for overall survival whereas only adjuvant chemotherapy and Charlson comorbidity score were predictive of disease free survival.

CONCLUSION

This article provides a template for the effective restructuring of pancreatectomy pathways during a pandemic with associated lockdowns and provides the first evidence that the quality of outcomes can be maintained in this difficult environment. It is hoped that these results will provide a framework for addressing surgical oncology challenges in future pandemics.

Identifying predictors of COVID-related delays in cancer-specific medical care

PURPOSE

Evidence of the impact of the COVID-19 pandemic on cancer prevention and control is growing, but little is known about patient-level factors associated with delayed care. We analyzed data from a survey focused on Iowan cancer patients' COVID-19 experiences in the early part of the pandemic.

METHODS

Participants were recruited from the University of Iowa Holden Comprehensive Cancer Center's Patients Enhancing Research Collaborations at Holden (PERCH) program. We surveyed respondents on demographic characteristics, COVID-19 experiences and reactions, and delays in any cancer-related health care appointment, or cancer-related treatment appointments. Two-sided significance tests assessed differences in COVID-19 experiences and reactions between those who experienced delays and those who did not.

RESULTS

There were 780 respondents (26% response), with breast, prostate, kidney, skin, and colorectal cancers representing the majority of respondents. Delays in cancer care were reported by 29% of respondents. In multivariable-adjusted models, rural residents (OR 1.47; 95% CI 1.03, 2.11) and those experiencing feelings of isolation (OR 2.18; 95% CI 1.37, 3.47) were more likely to report any delay, where experiencing financial difficulties predicted delays in treatment appointments (OR 5.72; 95% CI 1.96, 16.67). Health insurance coverage and concern about the pandemic were not statistically significantly associated with delays.

CONCLUSION

These findings may inform cancer care delivery during periods of instability when treatment may be disrupted by informing clinicians about concerns that patients have during the treatment process. Future research should assess whether delays in cancer care impact long-term cancer outcomes and whether delays exacerbate existing disparities in cancer outcomes.

Delivering Safe Surgical Care While Simultaneously Caring for Patients With COVID-19; Assessment of Patient Selection, Volume and Outcomes in a Tertiary Care Hospital

Objectives: Compare patient selection and postoperative outcomes after surgical treatment for gastrointestinal disorders before and during the SARS-CoV-2 pandemic.

Methods: We assessed gastrointestinal surgeries conducted at a tertiary center from 2017–2021 for differences in patient populations and procedures before (up to February 2020) and during the pandemic (March 2020 to December 2021). We analyzed mortality, Intensive Care Unit (ICU) length of stay, admission to ICU and postoperative complications for complex procedures using descriptive statistics and regression models.

Results: 7309 procedures were analyzed, showing a caseload reduction in March and October 2020, but no statistical evidence for fewer overall procedures overall. Population characteristics differed with lower Body Mass Indices in 2020 and 2021, more patients smoking and with diabetes treated in 2020. There was no increased mortality, ICU length of stay and in 1,144 complex procedures assessed low overall morbidity at 90 days postoperative.

Conclusion: Delivering surgical care while treating patients for COVID-19 in the same hospital was safe. Healthcare officials should consider continuing surgical care during future health crises as consequences of limiting surgical treatment for gastrointestinal disorders may be fatal for patients.