The impact of COVID-19 for postoperative outcomes using a nationwide Japanese database of patients undergoing distal gastrectomy for gastric cancer

Background: The coronavirus disease 2019 (COVID-19) pandemic had resulted in either failure to provide required medical resources or delayed treatment for gastric cancer patients. This study aimed to investigate the impact of COVID-19 on the incidence of postoperative complications using a nationwide Japanese database of patients undergoing distal gastrectomy for gastric cancer. Method(s): We collected the data of patients who underwent distal gastrectomy from January 2018 to December 2021 from the National Clinical Database (NCD), a web-based surgical registration system in Japan. The number of surgical cases, the use of intensive care units, and the incidence of morbidity per month were analyzed. We also calculated the standardized mortality ratio (SMR), defined as the ratio of the number of observed patients to the expected number of patients calculated using the risk calculator established in the NCD, for several morbidities, including pneumonia, sepsis, 30-day mortality, and surgical mortality. Result(s): A decrease of 568 gastrectomies was observed from April 2020 to May 2020. Although the absolute number of patients admitted to intensive care units had declined since 2020, the proportion of patients admitted to the ICU did not change before and after the pandemic. Mortality and critical morbidity (such as pneumonia and sepsis) rates were not worse during the pandemic compared to pre-pandemic periods per the SMR. Conclusion(s): Surgical management was conducted adequately through the organized efforts of the entire surgery department in our country even in a pandemic during which medical resources and staff may have been limited.Copyright © 2023 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery.

Cause-of-death statistics in 2020 in the Republic of Korea.

Background: This study analyzed the causes of death in the Korean population in 2020. Method(s): Cause-of-death data for 2020 from Statistics Korea were examined based on the Korean Standard Classification of Diseases and Causes of Death, 7th revision and the International Statistical Classification of Diseases and Related Health Problems, 10th revision. Result(s): In total, 304,948 deaths occurred, reflecting an increase of 9,838 (3.3%) from 2019. The crude death rate (the number of deaths per 100,000 people) was 593.9, corresponding to an increase of 19.0 (3.3%) from 2019. The 10 leading causes of death, in descending order, were malignant neoplasms, heart diseases, pneumonia, cerebrovascular diseases, intentional self-harm, diabetes mellitus, Alzheimer disease, liver diseases, hypertensive diseases, and sepsis. Cancer accounted for 27.0% of deaths. Within the category of malignant neoplasms, the top 5 leading organs of involvement were the lung, liver, colon, stomach, and pancreas. Sepsis was included in the 10 leading causes of death for the first time. Mortality due to pneumonia decreased to 43.3 (per 100,000 people) from 45.1 in 2019. The number of deaths due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 950, of which 54.5% were in people aged 80 or older. Conclusion(s): These changes reflect the continuing increase in deaths due to diseases of old age, including sepsis. The decrease in deaths due to pneumonia may have been due to protective measures against SARS-CoV-2. With the concomitant decrease in fertility, 2020 became the first year in which Korea's natural total population decreased.Copyright © Korean Medical Association.

Psychological Factors of Early Diagnosis of Malignant Neoplasms of the Most Common Localizations (On the Example of Lung Cancer and Stomach Cancer)1

Introduction. Solving the problem of survival and effectiveness of treatment of patients with malignant neoplasms, improving their quality of life is a national goal and a strategic task for the development of the Russian Federation. However, due to the COVID-19 pandemic, which has imposed restrictions on many areas of people's lives, including healthcare, the number of cancer detections in the late stages of the disease has increased tremendously. This trend will inevitably lead to an increase in the number of cancer patients, as well as mortality. The aim of this study is to identify psychological factors associated with early detection of lung cancer and gastric cancer. Materials and methods. Methods for diagnosing psychological predictors of early diagnosis of lung cancer and stomach cancer were survey methods: the scale of world assumptions, Janoff-Bulman R., adaptation of M. A. Padun, A. V. Kotelnikova;methodology of the Level of subjective control (E. F. Bazhin, E. A. Golynkina, L. M. Etkind);Life Orientation Test, Scheier M. F., Carver C. S, adapted by Tsiring D. A., Evnina K. Yu.), Hardiness Survey, S. Maddi, adapted by D. Leontiev). As methods for quantitative processing of empirical data: methods of descriptive statistics, one-way analysis of variance, discriminant analysis. The design of the study involves the analysis of the psychological characteristics of patients with lung cancer (N=26) and stomach cancer (N=32) at various stages of the disease. Results. According to the data obtained, early diagnosis of patients with gastric cancer depends on coping behavior, in particular strategies such as taking responsibility and planning to solve the problem. These coping behaviors are adaptive, encouraging patients to use more adaptive coping mechanisms. Also, according to the data obtained, early diagnosis of patients with lung cancer depends on the locus of control in the field of interpersonal relationships (internal locus of control), low pain intensity and its impact on the ability to engage in daily activities, features of coping behavior, in particular, the lack of a confrontation strategy. Conclusion. The results of the study of psychological predictors of early diagnosis of gastric cancer and lung cancer revealed specific psychological predictors for each localization of malignant neoplasms. A more complete understanding of the psychological factors of early cancer diagnosis may be useful for understanding how psychological personality traits can affect the timeliness of patients seeking cancer treatment, the provision of psychological and supportive services to cancer patients at various stages of the disease, and the identification of patients at risk who are prone to late cancer. seeking oncological treatment.

Out-of-hospital management strategies for gastric cancer patients during the COVID-19 outbreak.

Since the outbreak of Corona Virus Disease 2019 occurred in December 2019, the reduction of population mobility has curbed the spread of the epidemic to some extent but also prolonged the waiting time for the treatment of patients with gastric cancer. Based on fully understanding the different staging characteristics of gastric cancer, clinical departments should develop reasonable out-of-hospital management strategies. On one hand, reasonable communication channels should be established to allow patients to receive adequate guidance out of the hospital. On the other hand, shared decisions with patients should be made to adjust treatment strategies, and education on viral prevention should be implemented to minimize the impact of the epidemic on tumor treatment.Copyright © 2020 by the Chinese Medical Association.

Original Article Evaluation of clinical outcomes, laboratory and imaging data of patients with solid tumor infected with COVID-19 infection

Background: COVID-19 is associated with higher mortality rates in patients with cancer. In this study, we aimed to evaluate the clinical outcomes, and laboratory and imaging data of patients with solid tumor infected with COVID-19 infection. Method(s): This is a cross-sectional retrospective study performed in 2020-2022 on 85 patients with a previous diagnosis of solid tumors infected with COVID-19. We included all patients with tumors of solid organs that were diagnosed with COVID-19 infection and required hospitalization those patients previously hospitalized for treatments and were infected with COVID-19 during hospitalization. Demographic data of patients were collected using a checklist. We collected data regarding clinical outcome (discharge, hospitalization or death), duration of hospitalization, requiring ICU admission, duration of hospitalization divided by received drugs and type of tumor and mean survival time. Furthermore, we collected laboratory data from all patients. The radiologic characteristics of patients were also extracted from their data. Result(s): Breast cancer was the most common solid tumor (34.9%), followed by lung cancer (19.3%). The mortality rate was 24.1% (20 patients). The highest mortality rate in this study was for metastatic intestinal cancer to the lung (100%, one patient), followed by metastatic prostatic cancer to lung (50%, three patients). The highest hospitalization duration was for patients with glioblastoma multiform (GBM) (30 days). The mean survival time among patients with mortality was 19.15+/-1.80 days. The mean CT severity score of all patients was 27.53+/-22.90. Patient's most common radiologic sign was air space consolidation (89.1%). The highest CT severity score was found in patients with stomach cancer (46.67+/-5.77). Conclusion(s): The mortality rate in this study was 24.1%. Based on the results of our study and previous research, special care should be provided to patients with solid tumors during the COVID-19 pandemic and in infected cases.Copyright © 2022, E-Century Publishing Corporation. All rights reserved.

Early mortality following COVID-19 infection among cancer patients who received radiotherapy: a meta-analysis

Introduction: Identifying the patients at higher risk for poor outcomes after radiotherapy (RT) during coronavirus disease 19 (COVID-19) era is an unmet clinical need. Methods: The Ovid MEDLINE, Ovid Embase, Clarivate Analytics Web of Science, PubMed and Wiley-Blackwell Cochrane Library databases were searched. Eligible studies were required to address the outcomes of cancer patients who underwent RT during the COVID-19 era. The primary outcome was early mortality, while secondary outcomes included length of hospital stay, hospital admission, intensive care unit (ICU) admission and use of mechanical ventilation. Pooled event rates were calculated, and meta-regression and 'leave-one-out' sensitivity analyses were performed. Results: Twelve eligible studies were included out of 928. The prevalence of early mortality after COVID-19 infection was 21.0%. The prevalence of hospital admission, ICU admission and mechanical ventilation was 78.1, 15.4 and 20.0%, respectively. Meta-regression showed that older age was significantly and positively associated with early mortality (β = 0.0765± 0.0349, p = 0.0284), while breast cancer was negatively associated with early mortality (β=-1.2754±0.6373, p = 0.0454). Conclusions: Older age adversely impacts the early mortality rate in cancer patients during COVID-19 era. The risks of interruption/delay of cancer treatment should be weighed against the risk of increased morbidity and mortality from the infection. A global registry is needed to establish international oncologic guidelines during the COVID-19 era. © 2021 The Author(s).

Inpatient Mortality in People With Type 2 Diabetes: A Cross-sectional Study

Objective: This study aimed to estimate inpatient mortality rate for diabetes and identify its associated factors. Material(s) and Method(s): This is a cross-sectional study. The population was comprised between January 1 and December 31, 2019 in 32 public hospitals in Portugal, using summary hospital discharge data. We used both the Disease-Related Diagnosis Groups and the Disease Staging. Patients were grouped into survivors and non-survivors, and inpatient mortality was compared using competing event regression. Result(s): A total of 7980 patients were admitted with type 2 diabetes mellitus, there were 747 (10.3%) non-survivors. The advanced age (OR = 1.772;95% CI 1.625-1.932), the stage (3) severity of type 2 diabetes mellitus (OR = 4.301;95% CI 2.564-7.215), comorbid lung, bronchial or mediastinal malignant neoplasm (OR = 5.118;95% CI 2.222-11.788), comorbid bacterial pneumonia (OR = 3.214;95% CI 2.539-4.070), other respiratory system disorders (OR = 2.187;95%CI1.645-2.909),comorbidrhino-,adeno-andcorona-virus infections (OR = 1.680;95% CI 1.135-2.488) were determinants for inpatient mortality. Conclusion(s): Elderly patients with diabetes with micro- and macrovascular complications of the disease, who have bacterial pneumonia and who enter the emergency department are those who have a lower survival rate. Copyright © 2022 Via Medica. All rights reserved.

Quality of death in cancer patients managed by gastroenterologists

Background: Care in hospitals is generally focused on prolonging life and may not adequately address the needs of dying patients. The incidence of oncologic diseases is rising, and efforts should be made to guarantee a better quality of death and dying. Aim: to evaluate the end-of-life care in patients with cancer under gastroenterologist care. Methods: Cross-sectional study including all in-patients with cancer who deceased in a Gastroenterology department in Portugal between 2012-2021. Demographic characteristics, clinical attitudes, therapeutic interventions and symptom control up to 6 months prior to the patient’s death were assessed. Results: We included 120 patients, 73% male, mean age 71±12.5 years. The most common cancers were hepatocellular carcinoma (35%), gastric cancer (16%), pancreatic cancer (15%) and cholangiocarcinoma (14%). One third of the patients had ECOG of 0-1 at admission and 77% (n=92) had advanced disease (stage IV or Barcelona Clinic Liver Cancer C/D). The median number of emergency consultations and hospitalizations in the 6 months before death was 2 (IQR 1-4). In their last month of life, the median time of hospitalization was 21.5 (IQR 12-25) days. It was documented the presence of an available caregiver in 56%(n=68) and spiritual support in only 2% (n=2) of the cases. One quarter of the patients experienced not adequately controlled pain and 72% received opioids. Palliative care consultation occurred in 60% (n=72) with a median time between that and death of 12 (IQR 3-18) days. Invasive procedures (diagnostic and therapeutic endoscopy, ERCP and EUS) were performed in half of the patients, achieving technical and clinical success in 62% (n=38) and 32% (n=19) of the cases, respectively. The mean time between those interventions and death was 12±10 days. The prognosis was discussed with the patient and family in 35% and 68% of the cases, respectively. At least 73% of the patients had visits at the end of life, which was negatively affected by the COVID-19 pandemic (p=0.022). Conclusions: In our cohort, we found a high hospitalization length of stay in the last month of life and high percentage of invasive treatments until shortly before dying. Thus, it is urgent to define and implement metrics of quality of death to prevent futile/potentially inappropriate treatment. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Serum miR-101, HSP-70 and IL-1 beta in gastric cancer patients with hp infection correlation between expression level and tmor proliferation and invasion

Objective: To investigate correlation between expression level and tumor proliferation and invasiveness of the serum miR-101, heat shock protein-70 (HSP-70) and interleukin-1beta (Interleukin-1beta, IL-1beta) in patients with gastric cancer complicated by Helicobacter pylori (Hp) infection.

A RETROSPECTIVE REVIEW OF 'MISSED' OESOPHAGEAL/GASTRIC CANCER DIAGNOSES AT MACCLESFIELD DISTRICT GENERAL HOSPITAL (MDGH)

Introduction There are approximately 15,000 new diagnoses of oesophageal and gastric cancer every year, in the UK (Cancer Research UK, 2022). Timely detection of cancer remains a key marker in prognosis and success of disease outcomes. Upper GI cancers diagnosed within 36 months of a previous oesophago-gastro-duodenoscopy (OGD) are defined as 'missed' cancer diagnoses. The British Society of Gastroenterology (BSG) states the acceptable rate of missed cancers is 10% or less (Beg S et al., 2017). Methods Retrospective case audit of 71 patients (6 patients excluded, 65 patients analysed), derived from the Somerset database, split into two cohorts of 2019-20 (pre- COVID-19 pandemic) and 2020-21 (during pandemic). Patient demographics, endoscopic, radiological and pathology reports of those diagnosed with oesophageal and gastric cancers were analysed. The number of endoscopies in the preceding 36 months were audited against BSG guidelines, to determine 'missed' cancer diagnoses. Results There were 47 male patients and 18 female patients in the cohort. The average age of patients (in years) diagnosed with oesophageal/gastric cancers in this sample population was 71.6. The age range of the sample population ranged from 50 years to 94 years. Total number of oesophageal cancers diagnosed in 2019-20 and 2020-21 were 31 and 15, respectively. The total number of gastric cancers diagnosed in 2019-20 and 2020-21 were 14 and 5, respectively. The total population area served by the hospital is approximately 200,000 people. The proportion of patients diagnosed with oesophageal/gastric cancer, during the audit timescale, who had had an endoscopy in the preceding 36 months was 7.7%. Accounting for explained anomalies, the number of patients who were diagnosed with a post-OGD oesophageal/gastric cancer was below the nationally acceptable upper limit for 'missed' cancers (10%). Conclusions 1) There was a reduction in the number of diagnoses of oesophageal and gastric cancers during the pandemic period, compared to the pre-pandemic period 1) The 'missed' oesophageal and gastric cancer rate was below the national acceptable limit of 10% 2) The emphasis on quality of endoscopy, regular training, use of descriptive classifications, image capture, biopsy numbers and minimum examination time of at least 7 minutes should be adhered to, to continue to improve detection rates (Beg S et al., 2017) 3) Further evaluation with artificial intelligence-based technology for lesion recognition should be evaluated to consider further reduction in rates of 'missed' cancer.

Colorectal and gastric cancer screening rates in Korea during the COVID-19 pandemic

Background: The COVID-19 pandemic has disrupted healthcare delivery, which is widely discussed as the distraction effect. This study aimed to estimate the distraction effect of the COVID-19 pandemic in Korea by analyzing colorectal and gastric cancer screening rates in the years 2019 and 2020. Methods: Information of eligible population who had colorectal and gastric cancer screening provided by the National Cancer Screening Program in the years 2019 and 2020 was collected. Participation rates were analyzed by age group, sex, geographic region, and calendar month. Percentage change was calculated by dividing the percentage point difference by the screening rate of the reference period (2019). Results: Overall, the colorectal and gastric cancer screening rates had decreased in 2020, compared to the reference period. For colorectal cancer, the screening rate decreased from 68.3% in 2019 (5,886,319 participants/14,526,424 eligible population) to 54.6% in 2020 (5,135,218/9,410,525) For gastric cancer, the screening rates decreased from 61.9% in 2019 (7,194,489/11,625,627) to 54.6% in 2020 (6,244,491/11,439,246). In March, during the first wave, the screening rates declined sharply (percentage change: colorectal, 56.6%;gastric, 57.3%). Although the screening rates had rebounded aftermath, they declined again in December, during the third wave (percentage change: colorectal, 17.0%;gastric, 13.8%). According to specific-age group, we found a substantial decline in screening rates for older adults aged 80∼84, and those over 85 (percentage change: colorectal, 19.0% & 23.0%;gastric, 17.4% & 25.1% respectively). Conclusion: During the COVID-19 pandemic, the screening rates for both colorectal and gastric cancer decreased. There was a substantial decline during the first and the third waves of the epidemic, in March and in December. The older adults group showed the highest reduction in screening rates. However, comparing the screening rate by region and sex, we did not find a significant difference. Delayed cancer diagnosis or excess death due to distraction effect of the COVID-19 pandemic has not yet been detected in Korea, therefore, further studies are needed.

PD-1 The impact of COVID-19 on diagnosis, stage and treatment of esophageal and gastric cancer

Background: During the COVID-19 pandemic, a profound decrease in the number of cancer diagnoses was observed. For patients with esophagogastric cancer, a diagnostic delay may have resulted in more advanced disease at the time of diagnosis. Also, downscaling of oncological care during COVID-19 may have resulted in postponed or different treatments. Therefore, we aimed to investigate the effects of the COVID-19 pandemic in 2020 on the stage at diagnosis and oncological care of esophagogastric cancer. Methods: Patients who were diagnosed in 2020 and included in the Netherlands Cancer Registry were allocated to 5 periods that correspond to the severity of the COVID-19 pandemic in the Netherlands. These were compared to patients diagnosed in the same period in the years 2017-2019. The number of diagnoses, tumor characteristics, type of treatment, time until the start of treatment and, in case of resection, the time between neoadjuvant therapy and resection were evaluated for esophageal cancer (EC) and gastric cancer (GC) separately. Results: The 2020 cohort in the Netherlands consisted of 2388 EC patients and 1429 GC patients. The absolute number of diagnoses decreased most prominently in the months March and April of 2020 for both EC and GC. The total number of EC diagnoses in 2020 decreased significantly compared to 2017-2019 (n=2522, p=0.027), whereas the total number of GC diagnoses did not decrease (n=1442, p=0.270). In the weeks after the first COVID-19 case in the Netherlands and before the COVID-19 lockdown, the percentage of incurable diagnoses increased from 52.5% to 67.7% for GC (p=0.011) and did not increase for EC (33.0% to 40.8%, p = 0.092). The percentage of patients with potentially curable EC receiving neoadjuvant chemoradiotherapy with resection decreased from 35.0% in 2017-2019 to 27.4% in 2020 (p < 0.001), whereas the percentage of patients receiving neoadjuvant chemoradiation without resection increased from 9.5% in 2017-2019 to 13.9% in 2020 (p < 0.001). The percentage of patients receiving definitive chemoradiation did not change significantly (p=0.119). For GC patients, no significant changes in type of treatment were found. The time between neoadjuvant chemotherapy and gastric resection decreased in 2020 with four days (p=0.006), while the time between neoadjuvant therapy and esophageal resection increased with 5 days (p=0.005). For both tumor types, the time between diagnosis and start of treatment was significantly shorter for patients diagnosed during and after the COVID-19 lockdown. Conclusions: We found a significant decrease in the number of EC diagnoses in 2020 and a shift in the type of treatment in potentially curable EC patients, with fewer resections being performed. Yet, it is unclear whether this is the result of the COVID-19 pandemic or due to an ongoing trial which implements watchful waiting after chemoradiotherapy. The oncological care for GC patients did not change during the COVID-19 pandemic. The shorter time between diagnosis and start of treatment may have been the result of a sense of urgency, since it was unknown in what way COVID-19 might affect the continuity of care in the upcoming future. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosures: All authors have declared no conflicts of interest.

PROVIDING GERIATRIC ONCOLOGY CARE USING TELEMEDICINE FOR OLDER PATIENTS WITH CANCER DURING THE COVID-19 PANDEMIC IN MEXICO

Introduction Telemedicine has played a pivotal role during the COVID-19 pandemic, but concerns exist about digital technology use among older adults, particularly those from resource limited settings. We aimed at understanding the feasibility of carrying out telemedicine interventions for older Mexican adults with cancer and limited access to technology. Methods Prospective study of telemedicine visits for patients aged ≥65 years with colorectal and gastric cancer at a Mexico City geriatric oncology clinic between 03/2020 and 03/2021. We evaluated contact methods, barriers for consultation, and the ability to undertake complex interventions such as geriatric assessments (GA) or chemotherapy (CT) prescriptions. Results Forty-four patients (median age 75) were included. The total number of visits was 167, with a median of 3 visits per patient. The preferred method of communication was WhatsApp videochat in 75%, followed by Zoom in 23%. 50% of visits took place using a family member's device. A GA (activities of daily living, nutritional assessment, psychological screening, falls assessment, polypharmacy review) was undertaken in 80% of visits, and CT was prescribed in 32%. Only 2.4% of visits could not be completed, and minor problems existed in 18%, the most relevant one being connection failures. Conclusions Telemedicine using freely available teleconference apps allowed for the completion of complex tasks, such as a GA and CT prescription in a population of older adults with low exposure to digital technology.

THE IMPACT OF COVID-19 ON THE ENDOSCOPY DEPARTMENT IN 2020 FROM THE EXPERIENCE OF A SINGLE JAPANESE INSTITUTION

AIM: We aimed to evaluate the impact of COVID-19 on endoscopy practices in areas where the number of COVID-19 was still low. METHODS: We compared the number of outpatients endoscopies performed, and cancellations at a Japanese tertiary endoscopy center between 2020 and 2019. In particular, we examined the changes in surveillance lost after endoscopic treatment for early-stage gastric cancer in the stomach. RESULTS: Of 14,146 scheduled examinations, 1233 (8.7%) were canceled or not seen in 2019, and in 2020, 1403 (10.5%) out of the scheduled 13,338 examinations. Both years, age <50 years, age >80 years, upper endoscopy, and experience of endoscopy in the past 5 years were significantly associated with cancelations. In 2020, cancelations in the 14th-26th week of the year, including the period of the state of emergency, increased significantly, and more women canceled. In 2020, 196 first follow-up examinations after endoscopic treatment of gastric cancer were scheduled, but 15 patients (7.7%) did not undergo the examination. This was more frequent than in 2019 (7.7% vs 3.6%, P = 0.08). CONCLUSIONS: In 2020, despite low numbers of COVID-19 cases in the area, the number of endoscopies decreased, and cancelation increased. The further research is needed on the future impact of a decrease in the number of endoscopies under a COVID-19 pandemic. (Table Presented).

Gastric Remnant Cancer: Complete Pathological Response - Case report

Background: Remnant gastric cancer (RGC) refers to carcinoma of the residual stomach occurring after gastrectomy. With an incidence of 1-7%, it is believed to have a different disease mechanism and a poorer prognosis than primary gastric cancer (PGC). However, due tu its rarity, the standard treatment for RGC remains undefined. Therefore, the multidisciplinary/tailored approach becomes crucial for the treatment of these patients. Materials and Methods: We present the case of a 64 years old male patient with family history of GC (father) and personal history of distal gastrectomy for peptic disease with Billroth-II reconstruction in 1979, orchiectomy for pT1 seminoma in 2017, and COPD. During follow-up for his seminoma the patient was diagnosed with clinical stage III intestinal type G1 gastric adenocarcinoma. The case was presented to our multidisciplinary team meeting (MDTm) and neoadjuvant treatment (FLOTx4) was started. In november 2019 an exploratory laparotomy was performed finding a RGC of the lesser curvature infiltrating the pancreas, the surgical team decided not to perform resection. The case was again presented in our MDTm and FLOT Protocol was completed (x4 cicles). CT scan showed good response and new laparotomy was planned. However, due to SARS-CoV2 outbreak the patient could not be operated on and was presented again to MDTm, deciding to proceed with chemoradiotherapy (50Gy + Taxol + CBP for 6 weeks). After the outbreak a new laparotomy was performed and a subtotal (95%) gastrectomy + Roux-n-Y reconstruction was performed. Results: After a period of 2 weeks in ICU due to aspiration pneumonia the patient recovered well and was discharged 23 days after surgery. Pathological report showed complete pathological response (grade 0) ypT0ypN0. The patient is currently well and will under surveillance. Conclusions: Although not as frequent as PGC, RGC is a disease with poor prognosis due to its diagnosis at advanced stages and the lack of standard treatment in current guidelines for both systemic and surgical treatment. In this setting, the role of MDTs and tailored treatments can contribute to both short- and long-term oncological outcomes and patient’s quality of life. In this case, FLOT followed by chemoradiotherapy (50Gy + Taxol + Carboplatinum) for 6 weeks, followed by subtotal gastrectomy allowed us to achieve a complete pathological response. Eventhough these results need further research, this could be a good treatment option in selected patients.

IMPACT OF COVID-19 INFECTION AMONG PATIENTS WITH PRE-EXISTING GASTROINTESTINAL CANCERS IN THE UNITED STATES: A MULTICENTER RESEARCH NETWORK STUDY

Background: Patients with underlying malignancy are considered to be at a higher risk of severe illness from COVID-19. However, the data on the COVID-19 related outcomes in patients diagnosed with major gastrointestinal cancers is lacking. We aimed to investigate the patients' characteristics and outcomes of COVID-19 infection in patients with a preexisting diagnosis of GI cancer. Methods: A search query was performed to identify all adult patients (≥ 18 years) diagnosed with COVID-19 between January 15, 2020, and July 15, 2020, on TriNet Database. The search criteria to identify potential COVID-19 patients were based on specific COVID-19 diagnosis codes or positive laboratory confirmation of COVID-19. Patients with COVID-19 and a diagnosis of the malignant esophagus, gastric, pancreatobiliary, hepatocellular, and colorectal cancer ever were included in the GI cancer group. Patients with COVID-19 who never had a diagnosis of GI cancer were included in the control group. The main outcomes were the 30-day risk for mortality, mechanical ventilation, and hospitalization after adjusting for confounding factors with 1:1 propensity score matching. For each outcome, the risk ratio (RR) with a 95% confidence interval (CI) was calculated to compare the outcomes. Results: A total of 434,375 adult patients from 40 HCO’s diagnosed with major GI cancers were identified in the Research Network. We identified a total of 1043 patients in the cancer group and 111,373 patients in the control group. Baseline demographics are described in the Table. More than half of the patients (53%) had a preexisting diagnosis of colorectal cancer while 19% of the patients had liver & intrahepatic bile duct cancers, and 15% had pancreato-biliary and 13% of patients were diagnosed with esophageal or gastric cancers. In crude analysis, COVID-19 patients with pre-existing GI cancers had a significantly higher risk of hospitalization (RR 2.37, 95% CI 2.19-2.55), mechanical ventilation (RR 2.16, 95% CI 1.69-2.75) and mortality (RR 3.81, 95% 3.14-4.63) compared to the control group. After PSM, the risk of hospitalization (RR 1.25, 95% CI 1.11-1.41) and mortality (RR 1.43, 95% CI 1.06-1.93) was still higher in COVID-19 patients with pre-existing GI cancers. However, mechanical ventilation was not significantly different in the matched groups (RR 1.91, 95% CI 0.84-1.71). Conclusion: Our study found that outcomes in patients with pre-existing GI cancers who had COVID-19 infection were worse in regard to hospitalizations and mortality. This difference persisted even after robust propensity score matching. COVID-19 patients with pre-existing GI cancers should be aggressively managed with close monitoring and can be prioritized for COVID-19 vaccination programs.(table presented) Baseline patient characteristics and 30 day outcomes in patients diagnosed with major GI cancers infected with COVID-19.