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Al-Saeedi M, Ramouz A, Khajeh E, Shraim S, Werba A, Polychronidis G, Mehrabi A, Loos M. Challenges and adaptations in pancreatic cancer surgery during the COVID-19 pandemic in a high-volume center. BMC Cancer 2025; 25:172. [PMID: 39881249 PMCID: PMC11780813 DOI: 10.1186/s12885-025-13512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 01/13/2025] [Indexed: 01/31/2025] Open
Abstract
BACKGROUND The COVID-19 pandemic affected healthcare systems worldwide, disrupting elective surgeries including those for cancer treatment. This study examines the effects of the pandemic on outcomes of pancreatic cancer surgeries at a specialized high-volume surgery center. MATERIALS AND METHODS This study compared surgical volume and outcomes of pancreas resections between the pre-pandemic (January 2019 to February 2020), early pandemic (March 2020 to January 2021), and late pandemic (February 2021 to December 2021) periods. Perioperative and postoperative data were retrospectively analyzed from a prospectively maintained database together with surgical complications, mortality rates, and hospital stays. RESULTS There was no significant reduction in the number of pancreas resections performed during the pandemic. The rate of primary resectable tumors was significantly lower during the late pandemic phase (66% vs. 65.9% vs. 56.5%; P = 0.024), and subsequently application of neoadjuvant therapies increased in the late pandemic phase (26% vs. 25.4% vs. 33.8%; P = 0.079). The number of chemotherapy cycles were also higher during the late pandemic phase (P = 0.009). Surgical complication rates were higher during the late pandemic phase (47.8% vs. 45.6% vs. 56%; P = 0.043), but mortality rates remained low (30-day mortality: 1.6% vs. 1% vs. 3.7%, P = 0.116; 90-day mortality: 2.5% vs. 1.6% vs. 3.7%, P = 0.296). CONCLUSION Our results indicate effective management of pancreatic cancer despite the challenges presented by the pandemic. These findings suggest that centralized, specialized surgical centers can maintain high-quality care of patients with pancreatic cancer during crises like the COVID-19 pandemic. These findings underscore the importance of timely surgical interventions for cancer patients, even when the healthcare system is disrupted.
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Affiliation(s)
- Mohammed Al-Saeedi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
- Division of Surgical Oncology, Department of General, Visceral, and Transplant Surgery, Ruprecht Karls University Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| | - Ali Ramouz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sakher Shraim
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Alexander Werba
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Georgios Polychronidis
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Martin Loos
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Lugnier C, Sommerlatte S, Attenberger U, Beer AJ, Bentz M, Benz SR, Birkner T, Büntzel J, Ebert MPA, Fasching P, Fischbach W, Fokas E, Fricke B, Hense H, Grohmann E, Hofheinz RD, Hüppe D, Huster S, Jahn P, Klinkhammer-Schalke M, Knauf W, Kraeft AL, Maier BO, Marckmann G, Niegisch G, Otto L, Pelzer U, Piso P, Rosenau H, Schmitt J, Schoffer O, Sehouli J, Tannapfel A, Wedding U, Wesselmann S, Winkler EC, Zimmermann T, Wörmann B, Reinacher-Schick A, Schildmann J. Prioritization and Resource Allocation in the Context of the COVID-19 Pandemic: Recommendations for Colorectal and Pancreatic Cancer in Germany. Oncol Res Treat 2024; 47:296-305. [PMID: 38484712 DOI: 10.1159/000538171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/28/2024] [Indexed: 06/06/2024]
Abstract
In the context of the COVID-19 pandemic, there has been a scarcity of resources with various effects on the care of cancer patients. This paper provides an English summary of a German guideline on prioritization and resource allocation for colorectal and pancreatic cancer in the context of the pandemic. Based on a selective literature review as well as empirical and ethical analyses, the research team of the CancerCOVID Consortium drafted recommendations for prioritizing diagnostic and treatment measures for both entities. The final version of the guideline received consent from the executive boards of nine societies of the Association of Scientific Medical Societies in Germany (AWMF), 20 further professional organizations and 22 other experts from various disciplines as well as patient representatives. The guiding principle for the prioritization of decisions is the minimization of harm. Prioritization decisions to fulfill this overall goal should be guided by (1) the urgency relevant to avoid or reduce harm, (2) the likelihood of success of the diagnostic or therapeutic measure advised, and (3) the availability of alternative treatment options. In the event of a relevant risk of harm as a result of prioritization, these decisions should be made by means of a team approach. Gender, age, disability, ethnicity, origin, and other social characteristics, such as social or insurance status, as well as the vehemence of a patient's treatment request and SARS-CoV-2 vaccination status should not be used as prioritization criteria. The guideline provides concrete recommendations for (1) diagnostic procedures, (2) surgical procedures for cancer, and (3) systemic treatment and radiotherapy in patients with colorectal or pancreatic cancer within the context of the German healthcare system.
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Affiliation(s)
- Celine Lugnier
- Department of Hematology and Oncology with Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Sabine Sommerlatte
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany,
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Bonn, Bonn, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, Ulm University Medical Center, Ulm, Germany
| | - Martin Bentz
- Department of Internal Medicine III (Hematology, Oncology, Infectious Diseases and Palliative Care), Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Stefan R Benz
- Department of General, Visceral, Thoracic and Pediatric Surgery, Hospital Boeblingen, Boeblingen, Germany
| | - Thomas Birkner
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jens Büntzel
- Department of Palliative Medicine, Südharz Klinikum Nordhausen, Nordhausen, Germany
| | - Matthias P A Ebert
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Peter Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | | | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany
| | - Birgit Fricke
- Arbeitskreis der Pankreatektomierten (AdP) e.V., Bonn, Germany
| | - Helene Hense
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Ralf-Dieter Hofheinz
- Department of Medical Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Dietrich Hüppe
- Speaker of the Colorectal Carcinoma Specialist Group, Professional Association of Resident Gastroenterologists (BNG), Herne, Germany
| | - Stefan Huster
- Institute for Social and Health Law, Ruhr University Bochum, Bochum, Germany
| | - Patrick Jahn
- Health Services Research Working Group, Department of Internal Medicine, University Hospital Halle (Saale), Halle (Saale), Germany
| | | | - Wolfgang Knauf
- Center for Hematology and Oncology Bethanien, Frankfurt, Germany
| | - Anna-Lena Kraeft
- Department of Hematology and Oncology with Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Bernd Oliver Maier
- Department for Palliative Medicine and Interdisciplinary Oncology, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Georg Marckmann
- Institute of Ethics, History, and Theory of Medicine, LMU Munich, Munich, Germany
| | - Günter Niegisch
- Department of Urology, University Hospital and Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
- Center for Integrated Oncology (CIO) Düsseldorf, CIO Aachen Bonn Köln Düsseldorf, Dusseldorf, Germany
| | - Lutz Otto
- Arbeitskreis der Pankreatektomierten (AdP) e.V., Bonn, Germany
| | - Uwe Pelzer
- Department of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pompiliu Piso
- Department for General and Visceral Surgery, Krankenhaus Barmerzige Brueder Regensburg, Regensburg, Germany
| | - Henning Rosenau
- Interdisciplinary Scientific Center Medicine - Ethics - Law of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Olaf Schoffer
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ulrich Wedding
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - Simone Wesselmann
- Head of the Certification Division of the German Cancer Society, Berlin, Germany
| | - Eva C Winkler
- Section Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT), NCT Heidelberg, a Partnership between DKFZ and Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Tanja Zimmermann
- Department of Psychosomatics and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Bernhard Wörmann
- Division of Hematology, Oncology and Tumour Immunology, Department of Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anke Reinacher-Schick
- Department of Hematology and Oncology with Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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3
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Inwald EC, Klinkhammer-Schalke M, Müller-Nordhorn J, Voigtländer S, Gerken M, Behrens B, Fehm TN, Ortmann O. Auswirkungen der COVID-19-Pandemie auf das Krebsgeschehen in Deutschland. DIE GYNÄKOLOGIE 2024; 57:3-8. [DOI: 10.1007/s00129-023-05177-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/05/2025]
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4
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Uttinger KL, Brunotte M, Diers J, Lock JF, Jansen-Winkeln B, Seehofer D, Germer CT, Wiegering A. Diverticulitis patient care during the Covid-19 pandemic in Germany-a retrospective nationwide population-based cohort study. Langenbecks Arch Surg 2023; 408:447. [PMID: 38001302 PMCID: PMC10673984 DOI: 10.1007/s00423-023-03184-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE Coronavirus disease 2019 (COVID-19) impacted health care systems around the world. Despite a decrease in emergency admissions, an increased number of complicated forms of diverticulitis was reported. It was the aim of this study to analyze the pandemic impact on diverticulitis management in Germany. METHODS This is a retrospective population-wide analysis of hospital billing data (2012-2021) of diverticulitis in Germany. Patients were identified based on diagnosis (ICD10) and procedural codes to stratify by conservative and operative management. Primary outcome of interest was admission rates, secondary outcomes were rates of surgical vs conservative treatment and fraction of complicated clinical courses during the pandemic. RESULTS Of a total of 991,579 cases, 66,424 (6.7%) were admitted during pandemic lockdowns. Conservative treatment was the most common overall (66.9%) and higher during lockdowns (70.7%). Overall admissions and population adjusted rates of surgically treated patients decreased, the latter by 12.7% and 11.3%, corrected to estimated rates, in the two lockdowns. Surgery after emergency presentation decreased by 7.1% (p=0.053) and 11.1% (p=0.002) in the two lockdowns with a higher rate of ostomy and/or revision (+5.6%, p=0.219, and +10.2%, p=0.030). In-hospital mortality was increased in lockdown periods (1.64% vs 1.49%). In detail, mortality was identical in case of conservative treatment during lockdown periods (0.5%) but was higher in surgically treated patients (4.4% vs 3.6%). CONCLUSION During lockdowns, there was an overall decrease of admissions for diverticulitis, especially non-emergency admissions in Germany, and treatment was more likely to be conservative. In case of surgery, however, there was increased risk of a complicated course (ostomy, re-surgery), possibly due to patient selection.
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Affiliation(s)
- Konstantin L Uttinger
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, Würzburg, Germany.
- Department of Visceral, Transplant, Thoracic and Vascular Surgery Leipzig University Medical Center, Leipzig, Germany.
| | - Maximilian Brunotte
- Department of Visceral, Transplant, Thoracic and Vascular Surgery Leipzig University Medical Center, Leipzig, Germany
| | - Johannes Diers
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, Würzburg, Germany
| | - Johan Friso Lock
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, Würzburg, Germany
| | - Boris Jansen-Winkeln
- Department of General, Visceral and Oncological Surgery, St. Georg Hospital Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery Leipzig University Medical Center, Leipzig, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg Medical Center, Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg Medical Center, Würzburg, Germany
- Department of Biochemistry and Molecular Biology, University of Würzburg, Würzburg, Germany
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5
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De Santis KK, Helmer S, Barnes B, Kraywinkel K, Imhoff M, Müller-Eberstein R, Kirstein M, Quatmann A, Simke J, Stiens L, Christianson L, Zeeb H. Impact of the COVID-19 pandemic on oncological care in Germany: rapid review. J Cancer Res Clin Oncol 2023; 149:14329-14340. [PMID: 37507594 PMCID: PMC10590309 DOI: 10.1007/s00432-023-05063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES The COVID-19 pandemic affected medical care for chronic diseases. This study aimed to systematically assess the pandemic impact on oncological care in Germany using a rapid review. METHODS MEDLINE, Embase, study and preprint registries and study bibliographies were searched for studies published between 2020 and 2 November 2022. Inclusion was based on the PCC framework: population (cancer), concept (oncological care) and context (COVID-19 pandemic in Germany). Studies were selected after title/abstract and full-text screening by two authors. Extracted data were synthesized using descriptive statistics or narratively. Risk of bias was assessed and summarized using descriptive statistics. RESULTS Overall, 77 records (59 peer-reviewed studies and 18 reports) with administrative, cancer registry and survey data were included. Disruptions in oncological care were reported and varied according to pandemic-related factors (e.g., pandemic stage) and other (non-pandemic) factors (e.g., care details). During higher restriction periods fewer consultations and non-urgent surgeries, and delayed diagnosis and screening were consistently reported. Heterogeneous results were reported for treatment types other than surgery (e.g., psychosocial care) and aftercare, while ongoing care remained mostly unchanged. The risk of bias was on average moderate. CONCLUSIONS Disruptions in oncological care were reported during the COVID-19 pandemic in Germany. Such disruptions probably depended on factors that were insufficiently controlled for in statistical analyses and evidence quality was on average only moderate. Research focus on patient outcomes (e.g., longer term consequences of disruptions) and pandemic management by healthcare systems is potentially relevant for future pandemics or health emergencies.
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Affiliation(s)
- Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany.
| | - Stefanie Helmer
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Benjamin Barnes
- German Center for Cancer Registry Data, Robert Koch Institute (RKI), Berlin, Germany
| | - Klaus Kraywinkel
- German Center for Cancer Registry Data, Robert Koch Institute (RKI), Berlin, Germany
| | - Maren Imhoff
- German Center for Cancer Registry Data, Robert Koch Institute (RKI), Berlin, Germany
| | | | - Mathia Kirstein
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Anna Quatmann
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Julia Simke
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Lisa Stiens
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Lara Christianson
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
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6
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Reinacher-Schick A, Ebert MP, Piso P, Hüppe D, Schmitt* J, Schildmann* J. Effects of the Pandemic on the Care of Patients With Colorectal Cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:545-552. [PMID: 37427989 PMCID: PMC10546886 DOI: 10.3238/arztebl.m2023.0139] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, there was a decrease in the rates of diagnosis and treatment of cancer. However, only a few detailed analyses have been made to date regarding the effect of the pandemic on the care of cancer patients in Germany. Such studies are needed as the basis for well-founded recommendations on health-care delivery priorities during pandemics and other, comparable situations of crisis. METHODS This review is based on publications that were retrieved by a selective search of the literature for controlled studies from Germany on the effects of the pandemic on colonoscopies, first diagnoses of colorectal cancer (CRC), surgical procedures for CRC, and CRC-related mortality. RESULTS Compared to 2019, the rate of screening colonoscopies performed by physicians in private practice was 1.6% higher in 2020 and 4.3% higher in 2021. On the other hand, the rate of diagnostic colonoscopies in the inpatient setting was 15,7% lower in 2020, while that of therapeutic colonoscopies was 11.7% lower. According to the data evaluated here, first diagnoses of CRC were 2.1% less common in January to September in 2020 than they had been in 2019; according to routine data collected by the statutory health insurance provider GRK, surgery for CRC was 10% less common in 2020 than in 2019. With regard to mortality, sufficient data from Germany were lacking to draw definite conclusions. International modeling data suggest an increase in mortality due to decreased colorectal screening rates during the pandemic that may at least be partially compensated for by intensified screening strategies following the pandemic. CONCLUSION Three years after the onset of the COVID-19 pandemic, there is still only a limited evidence base for an evaluation of the effects of the pandemic on medical care and on the outcomes of patients with CRC in Germany. The implementation of central data and research infrastructures will be necessary for further study of the long-term effects of this pandemic, as well as to enable optimal preparedness for future crisis situations.
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Affiliation(s)
- Anke Reinacher-Schick
- Department of Hematology and Oncology with Palliative Care, St. Josef Hospital, Ruhr University Bochum, Germany
| | - Matthias Philip Ebert
- Department of Internal Medicine II and DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Germany
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Hospital Barmherzige Brueder Regensburg, teaching hospital of the University of Regensburg, Germany
| | | | - Jochen Schmitt*
- * These authors share last authorship. Additional contributors are listed in the eBox
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Technical University Dresden, Germany
| | - Jan Schildmann*
- * These authors share last authorship. Additional contributors are listed in the eBox
- Institute for the History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle, Germany
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Yurttas C, Schleicher C, Fischer I, Meisner C, Nadalin S, Königsrainer A, Löffler MW, Quante M. Einfluss der Coronapandemie auf die Leberchirurgie und
Lebertransplantationen in Deutschland. Zentralbl Chir 2022; 147:354-360. [PMID: 35863355 DOI: 10.1055/a-1845-1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Hintergrund Die Leberchirurgie ist durch ein hohes perioperatives Risiko
und einen großen Ressourcenaufwand geprägt, aber die Operationsindikation ist
oftmals alternativlos. Die SARS-CoV-2-Pandemie führte weltweit zu
Einschränkungen in der chirurgischen Patientenversorgung und stellte daher auch
die Leberchirurgie vor neue Herausforderungen. Welchen Einfluss die Pandemie
allerdings auf die Leberchirurgie in Deutschland insgesamt hatte, ist bislang
nur unzureichend bekannt.
Methoden Auf Basis der durch das Statistische Bundesamt (Destatis)
erfassten Daten zu Prozedurenschlüsseln (OPS-Codes) vollstationärer Patienten in
Deutschland aus den Jahren 2010–2020 sowie Daten zu Organtransplantationen der
Deutschen Stiftung Organtransplantation (DSO) wurde retrospektiv die Anzahl
leberchirurgischer Prozeduren in Deutschland zu Beginn der Pandemie mit den
Vorjahresdaten sowie mit Zahlen aus dem Eurotransplant-Raum verglichen.
Ergebnisse Entsprechend der durch das Statistische Bundesamt
dokumentierten Prozedurenschlüssel unterlagen Operationen an der Leber sowie
Lebertransplantationen in Deutschland in den Jahren 2010 bis 2020 einer
jährlichen Schwankung, die auch im Pandemiejahr 2020, im Gegensatz zu anderen
europäischen Ländern, unverändert geblieben ist. Die Entwicklung der
postmortalen Lebertransplantation sowie der Leberlebendspenden ist in
Deutschland, gemäß den Zahlen der DSO, auch im Jahr 2020 stabil geblieben.
Schlussfolgerungen Die Anzahl leberchirurgischer Eingriffe in Deutschland
unterlag bis 2020 einer dynamischen Entwicklung, die auch im 1. Pandemiejahr
2020 keine deutliche Veränderung gezeigt hat. Die häufigsten an der Leber
durchgeführten Operationen sowie die Lebertransplantation entwickelten sich auch
zu Beginn der Pandemie quantitativ weitgehend stabil. Die Veröffentlichung von
Daten zu den entsprechenden Prozedurenschlüsseln für das Jahr 2021 bleibt
abzuwarten, um die weitere Entwicklung der Leberchirurgie und -transplantation
in Deutschland während der SARS-CoV-2-Pandemie beurteilen zu können.
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Affiliation(s)
- Can Yurttas
- Klinik für Allgemeine, Viszeral- und
Transplantationschirurgie, Universitätsklinikum Tübingen, Tübingen,
Deutschland
| | - Christina Schleicher
- Deutsche Stiftung Organtransplantation - Region
Baden-Württemberg, Stuttgart, Deutschland
| | - Imma Fischer
- Institut für Klinische Epidemiologie und angewandte
Biometrie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Christoph Meisner
- Robert Bosch Gesellschaft für medizinische Forschung, Stuttgart,
Deutschland
| | - Silvio Nadalin
- Klinik für Allgemeine, Viszeral- und
Transplantationschirurgie, Universitätsklinikum Tübingen, Tübingen,
Deutschland
| | - Alfred Königsrainer
- Klinik für Allgemeine, Viszeral- und
Transplantationschirurgie, Universitätsklinikum Tübingen, Tübingen,
Deutschland
| | - Markus W. Löffler
- Abteilung für klinische Pharmakologie,
Universitätsklinikum Tübingen, Tübingen, Deutschland
- Exzellenzcluster iFIT (EXC2180) „Individualisierung von
Tumortherapien durch molekulare Bildgebung und funktionelle Identifizierung
therapeutischer Zielstrukturen (iFIT)", Eberhard-Karls-Universität Tübingen
Medizinische Fakultät, Tübingen, Germany
- Interfakultäres Institut für Zellbiologie, Abteilung
Immunologie, Eberhard Karls Universität Tübingen, Tübingen,
Deutschland
- Klinik für Allgemeine, Viszeral- und
Transplantationschirurgie, Universitätsklinikum Tübingen, Tübingen,
Deutschland
| | - Markus Quante
- Klinik für Allgemeine, Viszeral- und
Transplantationschirurgie, Universitätsklinikum Tübingen, Tübingen,
Deutschland
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Hassan M, Le UT, Grapatsas K, Passlick B, Schmid S. Onkologische Thoraxchirurgie während der COVID-19-Pandemie: eine Fallkontrollstudie zum Risiko für postoperative Komplikationen. TUMORDIAGNOSTIK & THERAPIE 2022; 43:268-274. [DOI: 10.1055/a-1795-8011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
Zusammenfassung
Hintergrund Die COVID-19-Pandemie hatte, neben der
offensichtlichen Bedeutung als eigenständige Erkrankung, einen schwerwiegenden Einfluss auf
alle Aspekte der medizinischen Versorgung. In der onkologischen Chirurgie mussten Operationen
verschoben werden oder es kam zu verzögerten Diagnosen onkologischer Erkrankungen, was neben
der Sorge um unzureichende Ressourcen auch in der Unsicherheit bezüglich der perioperativen
Risiken begründet lag. In dieser Studie untersuchen wir die Sicherheit der Durchführung
onkologischer thoraxchirurgischer Eingriffe während der COVID-19-Pandemie.
Patienten und Methoden Es wurden retrospektiv die Ergebnisse der
thoraxchirurgischen Operationen bei onkologischen Patienten am Universitätsklinikum Freiburg
während der 1., 2. und 3. Welle der COVID-19-Pandemie (vom 01.01. bis 30.04.2020 sowie vom
01.01. bis 30.04.2021) untersucht. Als Kontrollgruppe wurden die im gleichen Zeitraum vor der
Pandemie (2018 und 2019) durchgeführten Operationen gewählt. Der primäre Endpunkt war das
Auftreten postoperativer Komplikationen.
Ergebnisse 236 Operationen in der Pandemiekohorte und 227
Operationen in der Kontrollkohorte wurden in die Studie eingeschlossen. Es gab keinen
Unterschied in der Inzidenzrate von postoperativen Minor-Komplikationen (16,1% vs. 18,5%,
p = 0,5395) oder Major-Komplikationen (12,2% vs. 10,13%, p = 0,5563) zwischen der
Pandemiekohorte und der Kontrollkohorte. Es zeigte sich kein erhöhtes Risiko für postoperative
pulmonale Komplikationen in der Pandemiekohorte (Odds Ratio = 1,193, 95%-KI= 0,6515–2,203,
p = 0,8232). Eine COVID-19-Infektion nach der Operation trat bei 5 Patienten der
Pandemiekohorte auf (2,29%). Die postoperative Motilität innerhalb von 30 Tagen waren
vergleichbar zwischen der Pandemiekohorte und der Kontrollkohorte (2 (0,85%) vs. 1 (0,44%),
p > 0,9999). Es gab keine COVID-19-infektionsbedingte Mortalität.
Schlussfolgerung Die Durchführung von onkologischen
thoraxchirurgischen Operationen während der COVID-19-Pandemie ist, unter Einhaltung der
entsprechenden Sicherheitsmaßnahmen, sicher und weder mit einer erhöhten Komplikationsrate
noch einer erhöhten Mortalität verbunden.
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Affiliation(s)
- Mohamed Hassan
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Uyen-Thao Le
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | | | - Bernward Passlick
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Severin Schmid
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
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Inwald EC, Klinkhammer-Schalke M, Müller-Nordhorn J, Voigtländer S, Gerken M, Ortmann O. Auswirkungen der COVID-19-Pandemie auf die Inzidenz und Therapie von Krebserkrankungen. FORUM 2022; 37:198-203. [PMCID: PMC8972628 DOI: 10.1007/s12312-022-01068-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Die COVID-19-Pandemie hat weltweit gravierende Auswirkungen auf die Gesundheitsversorgung. Vorerkrankte Personen, insbesondere Krebspatient*innen, stellen dabei eine besonders vulnerable Gruppe dar. Die COVID-19-Pandemie hatte und hat sowohl national als auch international erhebliche Auswirkungen auf die Diagnostik und Therapie bei Krebspatient*innen. Bereits zu Beginn der Pandemie wurde über gravierende Einschränkungen bei der Abklärung von Krebserkrankungen sowie den Früherkennungsuntersuchungen berichtet. Es zeigten sich Verzögerungen bei der Krebsdiagnostik sowie ein erheblicher Rückgang der Zahl der diagnostizierten Krebsfälle. Patient*innen vermieden aus Sorge vor einer Ansteckung, medizinische Versorgung in Anspruch zu nehmen. Diese Faktoren können zu einer erhöhten Rate von Diagnosestellungen in fortgeschrittenen Tumorstadien führen. Eingeschränkte Versorgungskapazitäten haben Verzögerungen von Krebstherapien zur Folge. Therapiemodifikationen können den Verlauf und das Überleben von Patient*innen mit Tumorerkrankungen beeinflussen.
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Affiliation(s)
- Elisabeth C. Inwald
- Klinik für Frauenheilkunde und Geburtshilfe, Lehrstuhl der Universität Regensburg, Landshuter Str. 65, 93053 Regensburg, Deutschland
| | - Monika Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Deutschland
| | - Jacqueline Müller-Nordhorn
- Bayerisches Krebsregister, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Nürnberg, Deutschland
| | - Sven Voigtländer
- Bayerisches Krebsregister, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Nürnberg, Deutschland
| | - Michael Gerken
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Deutschland
| | - Olaf Ortmann
- Klinik für Frauenheilkunde und Geburtshilfe, Lehrstuhl der Universität Regensburg, Landshuter Str. 65, 93053 Regensburg, Deutschland
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10
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Hassan M, Le UT, Grapatsas K, Passlick B, Schmid S. [Surgery for Thoracic Malignancies during the COVID-19 Pandemic: a Case-control Study Investigating the Risk for Postoperative Complications]. Zentralbl Chir 2021; 146:579-585. [PMID: 34872113 DOI: 10.1055/a-1678-7533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The COVID-19 pandemic led to a major disturbance in the health care system. Many elective operations were postponed, including surgical oncology cases. Besides the need to contain hospital resources, this was also due to concerns about the safety to perform surgery during the pandemic and the impact of perioperative infections on postoperative outcomes. In this study we investigate the safety of surgery for thoracic malignancies during the COVID-19 pandemic. METHODS We retrospectively analysed the outcome of surgery for thoracic malignancies during the first, second and third waves of the COVID-19 pandemic (from 01.01. to 30.04.2020 and from 01.01. to 30.04.2021). As a control group we included the patients who received thoracic oncology surgeries during the same period in the last 2 years before the onset of the pandemic. The primary outcome was the rate of postoperative complications. RESULTS 236 operations were included in the pandemic group and 227 operations in the control group. There was no statistically significant difference in the rate of postoperative minor complications (16.1% vs. 18.5%, p = 0.5395) or major complications (12.2% vs. 10.13 %, p = 0.5563). The risk to develop postoperative pulmonary complications was not higher in the pandemic group (odds ratio 1.193, 95% CI 0.6515-2.203, p = 0.8232). There were 5 cases with COVID-19 infection after the operation in the pandemic group. There was no difference in the rate of postoperative mortalities (2 (0.85%) vs. 1 (0.44%), p > 0.9999) There was no COVID-19 related mortality. CONCLUSION Maintaining oncologic thoracic surgery during the COVID-19 pandemic is safe, feasible and not associated with increased risks of postoperative complications or mortalities.
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Affiliation(s)
- Mohamed Hassan
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Uyen-Thao Le
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | | | - Bernward Passlick
- Abteilung Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Severin Schmid
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
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