ABSTRACT
Purpose/Background: With enhanced strain on healthcare systems and avoidance of routine surgery and systemic therapy during the COVID-19 period due to increased morbidity and mortality alternative oncological approaches have been employed. We aimed to determine the variation in strategies adopted nationally across the United Kingdom (UK) and long-term associated outcomes. Methods/Interventions: A UK multi-centre prospective observational study was performed from the date of National Governmental lockdown (23/3/20) until the lifting of restrictions (17/5/21). Patients with a new diagnosis of rectal cancer or those rediscussed at MDT on an existing treatment pathway were eligible for inclusion. Results/Outcomes: The first 900 patients were reported from 70 registered sites;65.4% male, 73.6% >60 years old. 62.4% of patients were diagnosed following lockdown. 65.8% of MDTs had a partial or entirely virtual format. 22.8% of tumours were T4, with 4.3% local recurrence. Following lockdown there was a significant increase in the use of SCRT + delay from 10.0% to 18.7% (p < 0.0005), with a rate of 26.7% during the first wave. Comparably the rate of LCRT fell 53.3% to 18.0% (p < 0.0001). 86.2% of those undergoing surgery during the first wave had stoma formation, 26.0% of which due to COVID-19 concerns alone. 18.6% of patients were deemed to have received different management plans due to COVID-19. Conclusion/Discussion: The COVID-19 pandemic has led to variation in oncological treatment strategies for rectal cancer, most notably an increase in the use of SCRT radiotherapy, deferral of surgery and stoma formation. Whilst short-term data appears to suggest equivalence in outcomes compared to LCRT, caution needs to be shown whilst awaiting longer-term outcomes and ensuring robust follow up and safety netting to avoid long term harm.
ABSTRACT
Introduction: Post-operative pulmonary complications in perioperative SARS-CoV- 2 infection are associated with significant morbidity and mortality. To maintain a safe cancer service, the Countess of Chester Hospital adopted “Cold-site” operating and maintained ERAS principles for patients undergoing elective colorectal cancer surgery during the pandemic. A comparative assessment of service was undertaken for benchmarking purposes. Methods: A comparative retrospective audit was undertaken of consecutive patients undergoing elective colorectal cancer surgery from May to December 2019 and compared to May to December 2020. The Somerset Cancer Registry and electronic medical case records were used to obtain the data set. Outcomes measured were;approach to surgery;stoma rate;length of stay;level of care required;post-operative complications (>Clavien-Dindo 2) and survival at 30 days. Mann-Whitney U test and Chi-squared were used for analysis. Results: There were 44 and 50 elective colorectal cancer operations in 2019 and 2020 respectively. There was a significant difference in the median age (66:70;P = 0.03) but not in ASA grade (P = 0.14). The median length of stay was 5 and 4 days respectively (P = 0.06). There was a 17% reduction in laparoscopic approach to surgery in 2020 (57% vs 40%;P = 0.10). There was no difference in the stoma rate (P = 0.7), post-operative complication rate (P = 0.6), ITU admission rate (P = 0.14), length of ITU stay (P = 0.2) and 30-day mortality rates. Conclusion: “Cold-site” operating allows robust ERAS care to be adopted to ensure comparative outcomes for patients undergoing colorectal cancer surgery and was associated with a non-significant trend to shorter hospital stay during the COVID-19 pandemic.